Provider Demographics
NPI:1063691426
Name:MEISER ADULT FOSTER CARE HOME INC
Entity type:Organization
Organization Name:MEISER ADULT FOSTER CARE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PUMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-770-4650
Mailing Address - Street 1:4764 W BURT RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MI
Mailing Address - Zip Code:48457-9372
Mailing Address - Country:US
Mailing Address - Phone:989-770-4650
Mailing Address - Fax:
Practice Address - Street 1:4764 W BURT RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MI
Practice Address - Zip Code:48457-9372
Practice Address - Country:US
Practice Address - Phone:989-770-4650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL730007419320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0563044Medicaid