DIVINITY ADULT FAMILY HOME, LLC (NPI# 1598160186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598160186 |
| Entity Type | Organization |
| Organization Name | DIVINITY ADULT FAMILY HOME, LLC |
| Practice Address |
38718 Ne Christensen Rd La Center WA 98629-4731 |
| Practice Telephone | 3605189998 |
| Mailing Telephone | 3605189998 |
| Enumeration Date | 2014-10-26 |
| Last Update Date | 2014-10-26 |
| Authorized Official Name | AMBER LEE JACOBS (OWNER) |
| Authorized Official Telephone | 3605189998 |
| Authorized Official Credential | R.N. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
201140065RN | WA | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568862134 | Divinity Adult Family Home, LLC | Custodial Care Facility | 5902 Kansas St, Vancouver, WA 98661-6918 | 2014-09-02 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | DIVINITY ADULT FAMILY HOME, LLC | 5902 Kansas St, Vancouver, WA 98661 |
| Street Address |
38718 NE CHRISTENSEN RD |
| City | LA CENTER |
| State | WA |
| Zip Code | 98629-4731 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841368883 | La Center School District 101 | Local Education Agency (LEA) | 700 East 4th St., La Center, WA 98629 | 2006-11-30 |
| 1477183135 | Sara Massie | Registered Nurse | 29701 Ne 41st Ave, La Center, WA 98629-2004 | 2020-01-22 |
| 1386943140 | Derek A Tafoya | Massage Therapist | 7803 Ne 332nd St, La Center, WA 98629-2721 | 2011-03-19 |
| 1942530027 | Vafa Talebi | Registered Nurse | 33611 Ne 60th Ave, La Center, WA 98629-2723 | 2010-01-12 |
| 1669748075 | Diana Suzanne Daschel | Registered Nurse | 9917 Ne 322nd St, La Center, WA 98629-2843 | 2012-03-29 |
| 1730649831 | Karen Anne Kennedy | Nutritionist | 10015 Ne 339th St, La Center, WA 98629-2853 | 2019-03-23 |
| 1851807465 | Nikki Meadows | Licensed Practical Nurse | 34502 Nw 21st Ave, La Center, WA 98629-3001 | 2017-12-18 |
| 1285926774 | Sandy Paul Larkin | Pharmacist | 7110 Ne Ferris Rd, 7110 Ne Ferris Rd, La Center, WA 98629-3419 | 2011-05-03 |
| 1700153996 | Kellee England | Dental Hygienist | 35519 Ne 86th Ave, La Center, WA 98629-3511 | 2011-11-16 |
| 1154681187 | Jason Ronald Miller | Licensed Practical Nurse | 11309 Ne 359th St, La Center, WA 98629-3643 | 2012-05-23 |
| Find all providers in zip 98629 | ||||
| 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 |
|---|---|---|---|---|
| 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 | ||||
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| 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.