COUNTRY LIVING ADULT FAMILY HOME (NPI# 1780859330) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780859330 |
| Entity Type | Organization |
| Organization Name | COUNTRY LIVING ADULT FAMILY HOME |
| Practice Address |
21514 47th Ave E Spanaway WA 98387 |
| Practice Telephone | 2538756663 |
| Practice Fax Number | 2538756663 |
| Mailing Telephone | 2538756663 |
| Mailing Fax Number | 2538756663 |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-24 |
| Authorized Official Name | MRS. ERMELINDA V KNUPP (ADULT FAM HOME PROVIDER) |
| Authorized Official Telephone | 2538756663 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
750777 | WA | Nursing & Custodial Care Facilities |
| Street Address |
21514 47TH AVE E |
| City | SPANAWAY |
| State | WA |
| Zip Code | 98387 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124673934 | Mckenzie L Cooper | Behavioral Analyst | 27421 30th Ave E, Spanaway, WA 98387 | 2019-08-08 |
| 1902467442 | Lindsey Taylor Reynolds | Speech-Language Pathologist | Bethel High School, 22215 38th Ave E, Spanaway, WA 98387 | 2019-06-25 |
| 1700353299 | David York | Chiropractor | 18407 Pacific Avenue, Suite A-11, Spanaway, WA 98387 | 2018-11-01 |
| 1730669391 | Lindsey Copus | Speech-Language Pathologist | 516 176th E, Spanaway, WA 98387 | 2018-08-14 |
| 1023531720 | Rebecca Susan Callaway | Behavioral Analyst | 4606 216th St Ct E, Spanaway, WA 98387 | 2017-07-25 |
| 1780093666 | Ramandeep Grewal | Pharmacist | 20307 Mountain Hwy W, Spanaway, WA 98387 | 2014-08-05 |
| 1730464223 | Dawn Michelle Johnson | Counselor | 7714 197th Street Ct E, Spanaway, WA 98387 | 2011-10-15 |
| 1982929469 | Abracadabra Recovery Inc | Community/Behavioral Health | 18407 Pacific Avenue South, Spanaway, WA 98387 | 2010-03-29 |
| 1932348810 | Christine Ann Uhl | Specialist | 8306 205th St Ct East, Spanaway, WA 98387 | 2009-02-17 |
| 1205072659 | Karen Lynn Iverson | Specialist | 5410 184th. Street East, Bethel Schools, Spanaway, WA 98387 | 2009-01-06 |
| Find all providers in zip 98387 | ||||
| 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 |
|---|---|---|---|---|
| 1770906877 | Yun Suk Mann | Custodial Care Facility | 1802 150th St S, Spanaway, WA 98387-9019 | 2014-01-24 |
| 1710153937 | St Nino Adult Family Home | Custodial Care Facility | 19620 8th Ave E, Spanaway, WA 98387 | 2008-05-07 |
| 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.