Provider Demographics
NPI:1679073845
Name:BURNETT AFC LLC
Entity type:Organization
Organization Name:BURNETT AFC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-743-6291
Mailing Address - Street 1:2181 KENNETH ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-1358
Mailing Address - Country:US
Mailing Address - Phone:810-743-6291
Mailing Address - Fax:
Practice Address - Street 1:2181 KENNETH ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-1358
Practice Address - Country:US
Practice Address - Phone:810-743-6291
Practice Address - Fax:810-743-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility