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General NPI Number Information
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NPI Number | 1225647407
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Entity Type | Organization
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Legal Business Name | AVIAN ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 9427 194TH ST E
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City | GRAHAM
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State | WA
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Zip | 98338-8198
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Country | US
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Telephone | 253-271-7383
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Fax |
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Provider Business Mailing Address
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Address Line | 9427 194TH ST E
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City | GRAHAM
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State | WA
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Zip | 98338-8198
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | DEDAN NJOROGE
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Credential |
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Telephone | 253-310-1206
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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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