Provider Demographics
NPI:1942639521
Name:HERITAGE AFC HOME
Entity Type:Organization
Organization Name:HERITAGE AFC HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HALDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-473-6006
Mailing Address - Street 1:8933 GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1576
Mailing Address - Country:US
Mailing Address - Phone:269-473-6006
Mailing Address - Fax:
Practice Address - Street 1:8933 GEORGE AVE
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1576
Practice Address - Country:US
Practice Address - Phone:269-473-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF110320288311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility