Provider Demographics
NPI:1275240871
Name:PLEASANT PINES AFC LLC
Entity Type:Organization
Organization Name:PLEASANT PINES AFC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-679-2986
Mailing Address - Street 1:15063 180TH AVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-9513
Mailing Address - Country:US
Mailing Address - Phone:231-796-4757
Mailing Address - Fax:231-796-4757
Practice Address - Street 1:15063 180TH AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9513
Practice Address - Country:US
Practice Address - Phone:231-796-4757
Practice Address - Fax:231-796-4757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home