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General NPI Number Information
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NPI Number | 1184449944
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Entity Type | Organization
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Legal Business Name | CANDLEBERRY ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 7518 56TH PL NE
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City | MARYSVILLE
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State | WA
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Zip | 98270-9203
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Country | US
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Telephone | 425-583-0521
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Fax | 360-322-6619
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Provider Business Mailing Address
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Address Line | 7518 56TH PL NE
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City | MARYSVILLE
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State | WA
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Zip | 98270-9203
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Country | US
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Telephone | 425-583-0521
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Fax | 360-322-6619
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Authorized Official
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Title or Position | PROVIDER
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Name | J BILLINGTON W MWANGI
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Credential |
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Telephone | 425-583-0521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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