Provider Demographics
NPI:1720630734
Name:STONE RIDGE AFC
Entity Type:Organization
Organization Name:STONE RIDGE AFC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-335-4865
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:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility