Healthcare Provider Details

I. General information

NPI: 1780512459
Provider Name (Legal Business Name): GRANDE CREEK AFH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 N RIO GRANDE RD
OTIS ORCHARDS WA
99027-5016
US

IV. Provider business mailing address

3105 N RIO GRANDE RD
OTIS ORCHARDS WA
99027-5016
US

V. Phone/Fax

Practice location:
  • Phone: 509-869-3961
  • Fax:
Mailing address:
  • Phone: 509-869-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNE MUTUKU
Title or Position: PROVIDER/OWNER
Credential:
Phone: 509-869-3961