Provider Demographics
NPI:1942691191
Name:STONERIDGE ADULT FOSTER CARE
Entity Type:Organization
Organization Name:STONERIDGE ADULT FOSTER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:269-758-3388
Mailing Address - Street 1:4825 FRUIN RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:MI
Mailing Address - Zip Code:49021-8209
Mailing Address - Country:US
Mailing Address - Phone:269-758-3388
Mailing Address - Fax:269-758-3488
Practice Address - Street 1:4825 FRUIN RD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:MI
Practice Address - Zip Code:49021-8209
Practice Address - Country:US
Practice Address - Phone:269-758-3388
Practice Address - Fax:269-758-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL0803387163104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances