Provider Demographics
NPI:1376083162
Name:SOUTHVIEW AFC LLC
Entity Type:Organization
Organization Name:SOUTHVIEW AFC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/DESIGNEE
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAJEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-318-1961
Mailing Address - Street 1:6026 KALAMAZOO AVE SE
Mailing Address - Street 2:STE 296
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 56TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49548-5739
Practice Address - Country:US
Practice Address - Phone:616-318-1961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS410311381311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home