Provider Demographics
NPI:1245779057
Name:FIRST CARE LIVING
Entity type:Organization
Organization Name:FIRST CARE LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-419-0641
Mailing Address - Street 1:256 PALMER ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4722
Mailing Address - Country:US
Mailing Address - Phone:616-419-0641
Mailing Address - Fax:616-288-9177
Practice Address - Street 1:256 PALMER ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4722
Practice Address - Country:US
Practice Address - Phone:616-419-0641
Practice Address - Fax:616-288-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF410370132253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency