=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114663341
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1 EMPOWERING ADULT FAMILY HOME 2
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2022
-----------------------------------------------------
Last Update Date | 05/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6211 W SUNDANCE DR
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99208-9042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-957-5679
-----------------------------------------------------
Fax | 509-903-0530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6211 W SUNDANCE DR
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99208-9042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-957-5679
-----------------------------------------------------
Fax | 509-903-0530
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LEONARD NJUNGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-957-5679
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------