Provider Demographics
NPI:1760922637
Name:BRENDAS LITTLE ACRES LLC
Entity Type:Organization
Organization Name:BRENDAS LITTLE ACRES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/ADMINISTATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CANTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-897-8340
Mailing Address - Street 1:12068 36TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-9509
Mailing Address - Country:US
Mailing Address - Phone:616-897-8340
Mailing Address - Fax:616-897-8343
Practice Address - Street 1:12068 36TH ST SE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9509
Practice Address - Country:US
Practice Address - Phone:616-897-8340
Practice Address - Fax:616-897-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM410293632311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home