Provider Demographics
NPI:1124353743
Name:EITNIEAR AFC
Entity type:Organization
Organization Name:EITNIEAR AFC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE GIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EITNIEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-523-4031
Mailing Address - Street 1:5760 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MI
Mailing Address - Zip Code:49266-9840
Mailing Address - Country:US
Mailing Address - Phone:517-523-4031
Mailing Address - Fax:
Practice Address - Street 1:5760 HUDSON RD
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MI
Practice Address - Zip Code:49266-9840
Practice Address - Country:US
Practice Address - Phone:517-523-4031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF300296275320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI492666248OtherAFC HOME