BLUEBERRY HILLS ADULT FAMILY HOME (NPI# 1306017124) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306017124 |
| Entity Type | Organization |
| Organization Name | BLUEBERRY HILLS ADULT FAMILY HOME |
| Other Organization Name | GRACE LAND ADULT FAMILY HOME |
| Practice Address |
20613 Ne 176th Ave Battle Ground WA 98604-3608 |
| Practice Telephone | 3606874433 |
| Practice Fax Number | 3606879113 |
| Mailing Telephone | 3606874433 |
| Mailing Fax Number | 3606879113 |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2008-03-19 |
| Authorized Official Name | MRS. FE PANGAN CAVA (OWNER) |
| Authorized Official Telephone | 3606874433 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Grace Land Adult Family Home | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | BLUEBERRY HILLS ADULT FAMILY HOME, LLC | 213 Fielding St Ne, Orting, WA 98360-7467 |
| Street Address |
20613 NE 176TH AVE |
| City | BATTLE GROUND |
| State | WA |
| Zip Code | 98604-3608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194265421 | David Cotteleer | Physical Therapist | 14109 Ne 258th St, Battle Ground, WA 98604 | 2017-03-06 |
| 1235528936 | Jason Egbert | Optometrist | 1710 Sw 9th Ave Ste 112, Battle Ground, WA 98604 | 2015-01-18 |
| 1922413632 | Clearwater Escape | Clinic/Center | 118 South Parkway Ave # 215, Battle Ground, WA 98604 | 2014-06-23 |
| 1205171923 | Tiffany Alicia Natland | Massage Therapist | 119 S Parkway Ste 101a, Battle Ground, WA 98604 | 2012-12-06 |
| 1578812004 | Margaret Waddell | Dental Hygienist | 20516 Ne 101st Ct, Battle Ground, WA 98604 | 2012-08-30 |
| 1558678938 | Penny Marie Pastori | Pharmacist | 1201 Sw 13th Ave, Battle Ground, WA 98604 | 2010-09-08 |
| 1992026355 | Corey Michael Bretting | Massage Therapist | 614 East Main Street, Battle Ground, WA 98604 | 2010-06-18 |
| 1407009350 | Anna Lee Dunn | Massage Therapist | 309 N.e 1st St, Battle Ground, WA 98604 | 2008-10-23 |
| 1235393166 | Above Beyond Dentistry and Implants | Dentist | 1908 Nw 1st Way Suite 105, Battle Ground, WA 98604 | 2008-07-10 |
| 1770769150 | Jacqueline Siy Tan | Family Medicine | 2005 W Main St Ste 110, Battle Ground, WA 98604 | 2008-01-15 |
| Find all providers in zip 98604 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255598215 | Lyudmila V Palamaryuk | Custodial Care Facility | 9211 Ne 180th Way, Battle Ground, WA 98604-5290 | 2008-05-19 |
| 1679740716 | Jennifer E Griffis | Custodial Care Facility | 18905 Ne 121st Court, Battle Ground, WA 98604-7456 | 2008-05-08 |
| 1467623546 | Held Star, Inc. | Custodial Care Facility | 10213 Ne 184th St, Battle Ground, WA 98604-9406 | 2008-03-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043810534 | Apple Creek, Inc. | Custodial Care Facility | 513 W Washington Ave, Yakima, WA 98903-1308 | 2020-10-26 |
| 1649877952 | Chase House LLC | Custodial Care Facility | 7006 Opal Ct Sw, Lakewood, WA 98498-6408 | 2020-10-08 |
| 1821603275 | Maria Sigheartau | Custodial Care Facility | 16228 Ne 100th St, Redmond, WA 98052-3039 | 2020-09-12 |
| 1154947802 | Allan's Place Extended Comfort Care LLC | Custodial Care Facility | 3134 E 15th Ave, Spokane, WA 99223-5110 | 2020-06-18 |
| 1780205633 | Dina Grib | Custodial Care Facility | 31408 8th Ave S, Federal Way, WA 98003-5302 | 2020-05-01 |
| 1699307769 | Jane Thuo | Custodial Care Facility | 11722 Ne 134th St, Kirkland, WA 98034-2130 | 2020-02-06 |
| 1982244034 | Careplus Adult Family Home Inc | Custodial Care Facility | 1923 149th St Sw, Lynnwood, WA 98087-6310 | 2020-01-07 |
| 1548804578 | Aurita Estudillo Tagle | Custodial Care Facility | 7015 Carolina Ln, Vancouver, WA 98664-1558 | 2019-11-02 |
| 1841846409 | Genteel Inc | Custodial Care Facility | 781 Kaynor Rd, Ellensburg, WA 98926-8691 | 2019-08-09 |
| 1114589033 | Deborah Nordberg | Custodial Care Facility | 203 S 77th Ave, Yakima, WA 98908-1513 | 2019-07-01 |
| Find all providers with the same taxonomy | ||||
| City | BATTLE GROUND |
| Zip Code | 98604 |
Please comment or provide details below to improve the information on BLUEBERRY HILLS ADULT FAMILY HOME.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.