Provider Demographics
NPI:1881134617
Name:BERGSMA AFC LLC
Entity type:Organization
Organization Name:BERGSMA AFC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BERGSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-446-5451
Mailing Address - Street 1:1776 BRISTOL RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1441
Mailing Address - Country:US
Mailing Address - Phone:616-446-5451
Mailing Address - Fax:616-784-6197
Practice Address - Street 1:1675 3 MILE RD NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49544-1441
Practice Address - Country:US
Practice Address - Phone:616-784-6197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM410313774253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency