Healthcare Provider Details

I. General information

NPI: 1619814985
Provider Name (Legal Business Name): ENCARE1 ADULT FAMILY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17709 E INDIANA AVE
SPOKANE VALLEY WA
99016-8534
US

IV. Provider business mailing address

17709 E INDIANA AVE
SPOKANE VALLEY WA
99016-8534
US

V. Phone/Fax

Practice location:
  • Phone: 903-744-7704
  • Fax:
Mailing address:
  • Phone:
  • 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: ETHEL PHORO
Title or Position: PROVIDER
Credential:
Phone: 903-744-7704