Healthcare Provider Details

I. General information

NPI: 1558281147
Provider Name (Legal Business Name): GLAMOUR ADULT FAMILY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15808 NE 43RD ST
VANCOUVER WA
98682-7131
US

IV. Provider business mailing address

15808 NE 43RD ST
VANCOUVER WA
98682-7131
US

V. Phone/Fax

Practice location:
  • Phone: 425-599-7468
  • Fax: 360-828-5833
Mailing address:
  • Phone: 425-599-7468
  • Fax: 360-828-5833

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: KIDIST AMARE
Title or Position: OWNER
Credential:
Phone: 425-599-7468