Provider Demographics
NPI:1508305921
Name:AMANT AFC
Entity Type:Organization
Organization Name:AMANT AFC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEBOER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-818-2472
Mailing Address - Street 1:1018 WIDDICOMB AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4130
Mailing Address - Country:US
Mailing Address - Phone:616-228-4624
Mailing Address - Fax:616-588-6048
Practice Address - Street 1:1018 WIDDICOMB AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4130
Practice Address - Country:US
Practice Address - Phone:616-228-4624
Practice Address - Fax:616-588-6048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF410379501311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home