Provider Demographics
NPI:1942924758
Name:MAPLE GROVE AFC LLC
Entity Type:Organization
Organization Name:MAPLE GROVE AFC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SCHNAUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-350-7865
Mailing Address - Street 1:17460 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-9554
Mailing Address - Country:US
Mailing Address - Phone:231-220-9123
Mailing Address - Fax:
Practice Address - Street 1:17460 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9554
Practice Address - Country:US
Practice Address - Phone:231-220-9123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency