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General NPI Number Information
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NPI Number | 1205707486
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Entity Type | Organization
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Legal Business Name | RESURRECTION ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 14824 NE 81ST ST
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City | VANCOUVER
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State | WA
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Zip | 98682-3406
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Country | US
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Telephone | 571-665-9250
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Fax | 360-768-5289
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Provider Business Mailing Address
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Address Line | 14824 NE 81ST ST
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City | VANCOUVER
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State | WA
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Zip | 98682-3406
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Country | US
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Telephone | 571-665-9250
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Fax | 360-768-5289
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Authorized Official
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Title or Position | PROVIDER
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Name | MR. ABEBE M GOBEZE
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Credential |
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Telephone | 571-665-9250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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