Provider Demographics
NPI:1780112383
Name:SNOWDEN, COLENE A (AFC PROVIDER)
Entity type:Individual
Prefix:MRS
First Name:COLENE
Middle Name:A
Last Name:SNOWDEN
Suffix:
Gender:F
Credentials:AFC PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18331 TIPSICO LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8554
Mailing Address - Country:US
Mailing Address - Phone:810-629-0251
Mailing Address - Fax:810-629-0251
Practice Address - Street 1:18331 TIPSICO LAKE RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-8554
Practice Address - Country:US
Practice Address - Phone:810-629-0251
Practice Address - Fax:810-629-0251
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF630004934315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities