Provider Demographics
NPI:1215176144
Name:KELLY'S KARE AFC
Entity type:Organization
Organization Name:KELLY'S KARE AFC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AFC PROVIDER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-893-3626
Mailing Address - Street 1:7888 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-9494
Mailing Address - Country:US
Mailing Address - Phone:231-893-3626
Mailing Address - Fax:231-894-8646
Practice Address - Street 1:7888 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-9494
Practice Address - Country:US
Practice Address - Phone:231-893-3626
Practice Address - Fax:231-894-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF610275850320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities