1306097191 NPI number — BOYD'S ADULT FOSTER CARE HOME

Table of content: (NPI 1306097191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306097191 NPI number — BOYD'S ADULT FOSTER CARE HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOYD'S ADULT FOSTER CARE HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BOYD'S AFC HOME
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306097191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O.BOX 334
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT. MORRIS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-875-9633
Provider Business Mailing Address Fax Number:
810-875-9633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 W. FOURTH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-875-9633
Provider Business Practice Location Address Fax Number:
810-875-9633
Provider Enumeration Date:
10/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BOYD
Authorized Official First Name:
LUCILLE
Authorized Official Middle Name:
LOIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
810-875-9633

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  AM250008164 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AM250008164 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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