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General NPI Number Information
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NPI Number | 1255607198
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Entity Type | Organization
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Legal Business Name | SHERWOOD ADULT FAMILY HOME, LLC
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 11017 NE SHERWOOD DRIVE
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City | VANCOUVER
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State | WA
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Zip | 98686
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Country | US
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Telephone | 360-718-8543
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Fax | 360-718-8645
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Provider Business Mailing Address
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Address Line | 11017 NE SHERWOOD DRIVE
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City | VANCOUVER
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State | WA
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Zip | 98686
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Country | US
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Telephone | 360-718-8543
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Fax | 360-718-8645
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Authorized Official
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Title or Position | OWNER, OPERATOR
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Name | MRS. LAURIE M DAVIS
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Credential | RN00069341
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Telephone | 360-718-8543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 751565
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License Number State | WA
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