MEDICARE: NATIONWIDE ADULT FAMILY HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1639041288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONWIDE ADULT FAMILY HOME LLC

Provider Business Mailing Address
First Line	:	4708 N BOLIVAR CT
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216
Country	:	US
Telephone Number	:	509-960-7400
Fax Number	:	509-960-7400

Provider Business Practice Location Address
First Line	:	4708 N BOLIVAR CT
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216
Country	:	US
Telephone Number	:	509-960-7400
Fax Number	:	509-960-7400

Authorized Official
Title or Position	:	PROVIDER
Name	:	MR. STANLEY ADJEI ADJOWERH-NORTEY
Credential	:
Telephone Number	:	425-648-9329

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	09/23/2025

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