Healthcare Provider Details

I. General information

NPI: 1366968034
Provider Name (Legal Business Name): BRIGHT RAY AFH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 W LONEWOLF AVE
SPOKANE WA
99208-9311
US

IV. Provider business mailing address

5920 W LONEWOLF AVE
SPOKANE WA
99208-9311
US

V. Phone/Fax

Practice location:
  • Phone: 509-467-0106
  • Fax:
Mailing address:
  • Phone: 509-467-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60416090
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNIE KAMAU
Title or Position: OWNER
Credential:
Phone: 201-932-9285