Healthcare Provider Details

I. General information

NPI: 1801747472
Provider Name (Legal Business Name): ST. MARY ADULT FAMILY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 E BRIERWOOD DR
SPOKANE WA
99218-1718
US

IV. Provider business mailing address

1114 E BRIERWOOD DR
SPOKANE WA
99218-1718
US

V. Phone/Fax

Practice location:
  • Phone: 206-734-2830
  • Fax:
Mailing address:
  • Phone: 206-734-2830
  • Fax: 509-852-2103

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: MEHARENA BERHE ZERESENAI
Title or Position: OWNER
Credential: RN
Phone: 206-734-2830