Healthcare Provider Details

I. General information

NPI: 1508779836
Provider Name (Legal Business Name): AAAA CRYSTAL ROSE COMFORT ADULT FAMILY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 S HELENA ST
SPOKANE WA
99223-4313
US

IV. Provider business mailing address

4414 S HELENA ST
SPOKANE WA
99223-4313
US

V. Phone/Fax

Practice location:
  • Phone: 321-986-7803
  • Fax: 509-448-6800
Mailing address:
  • Phone: 321-986-7803
  • Fax: 509-448-6800

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: ROLDINE LAGUERRE
Title or Position: OWNER
Credential: RN
Phone: 321-986-7803