Provider Demographics
NPI:1962127340
Name:CHURCHILL FARMS AFC
Entity type:Organization
Organization Name:CHURCHILL FARMS AFC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-667-4802
Mailing Address - Street 1:1180 CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3023
Mailing Address - Country:US
Mailing Address - Phone:810-667-4802
Mailing Address - Fax:
Practice Address - Street 1:1180 CLIFF DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3023
Practice Address - Country:US
Practice Address - Phone:810-667-4802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness