Healthcare Provider Details

I. General information

NPI: 1124954011
Provider Name (Legal Business Name): WALLA WALLA AL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 WHITMAN ST
WALLA WALLA WA
99362-3400
US

IV. Provider business mailing address

1018 WHITMAN ST
WALLA WALLA WA
99362-3400
US

V. Phone/Fax

Practice location:
  • Phone: 509-781-9022
  • Fax:
Mailing address:
  • Phone: 509-781-9022
  • Fax:

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: CHRIS SPENCER
Title or Position: SR VP OF OPERATIONS
Credential:
Phone: 332-322-1990