Provider Demographics
NPI:1306399175
Name:AFB DIVERSIFIED, LLC
Entity type:Organization
Organization Name:AFB DIVERSIFIED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-390-3427
Mailing Address - Street 1:614 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1654
Mailing Address - Country:US
Mailing Address - Phone:256-543-8837
Mailing Address - Fax:256-543-8839
Practice Address - Street 1:614 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1654
Practice Address - Country:US
Practice Address - Phone:256-543-8837
Practice Address - Fax:256-543-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities