Provider Demographics
NPI:1215968268
Name:MERRIMAN ADULT FOSTER CARE
Entity type:Organization
Organization Name:MERRIMAN ADULT FOSTER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:MERRIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1810-238-9416
Mailing Address - Street 1:1405 WATCH HILL DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5625
Mailing Address - Country:US
Mailing Address - Phone:810-238-9416
Mailing Address - Fax:
Practice Address - Street 1:1405 WATCH HILL DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5625
Practice Address - Country:US
Practice Address - Phone:810-238-9416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4588749OtherMICH. F.I.A.