Provider Demographics
NPI:1336663061
Name:FAMILY TREE ADULT FOSTER CARE, INC.
Entity Type:Organization
Organization Name:FAMILY TREE ADULT FOSTER CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-873-7737
Mailing Address - Street 1:6699 N OCEANA DR
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-8422
Mailing Address - Country:US
Mailing Address - Phone:231-873-7737
Mailing Address - Fax:
Practice Address - Street 1:6699 N OCEANA DR
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-8422
Practice Address - Country:US
Practice Address - Phone:231-873-7737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM640384872311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAM640384872OtherSTATE LICENSING
MI0185492Medicaid