Healthcare Provider Details

I. General information

NPI: 1740194703
Provider Name (Legal Business Name): THE PROMISE ADULT FAMILY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 N BOLIVAR COURT
SPOKANE VALLEY WA
99216-2594
US

IV. Provider business mailing address

4707 N BOLIVAR COURT
SPOKANE VALLEY WA
99216
US

V. Phone/Fax

Practice location:
  • Phone: 509-798-8115
  • Fax: 509-267-1411
Mailing address:
  • Phone: 509-798-8115
  • Fax: 509-267-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIA HENTGES
Title or Position: PROVIDER
Credential:
Phone: 509-608-1097