Healthcare Provider Details

I. General information

NPI: 1902494610
Provider Name (Legal Business Name): BFG SPOKANE PROPCO IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 S FREYA ST
SPOKANE WA
99223-7135
US

IV. Provider business mailing address

506 N 40TH AVE STE 100
YAKIMA WA
98908-4330
US

V. Phone/Fax

Practice location:
  • Phone: 509-904-1245
  • Fax:
Mailing address:
  • Phone: 509-426-2756
  • Fax: 509-426-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: FAYE GORDON
Title or Position: DIRECTOR OF COMPLIANCE MGR
Credential:
Phone: 509-426-2756