Provider Demographics
NPI:1568946408
Name:PORTER PLACE AFC LLC
Entity Type:Organization
Organization Name:PORTER PLACE AFC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-603-1393
Mailing Address - Street 1:6191 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8540
Mailing Address - Country:US
Mailing Address - Phone:810-603-1393
Mailing Address - Fax:810-603-1394
Practice Address - Street 1:6191 PORTER RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8540
Practice Address - Country:US
Practice Address - Phone:810-603-1393
Practice Address - Fax:810-603-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home