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General NPI Number Information
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NPI Number | 1366968034
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Entity Type | Organization
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Legal Business Name | BRIGHT RAY AFH
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5920 W LONEWOLF AVE
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City | SPOKANE
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State | WA
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Zip | 99208-9311
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Country | US
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Telephone | 509-467-0106
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Fax |
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Provider Business Mailing Address
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Address Line | 5920 W LONEWOLF AVE
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City | SPOKANE
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State | WA
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Zip | 99208-9311
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Country | US
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Telephone | 509-467-0106
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNIE KAMAU
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Credential |
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Telephone | 201-932-9285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN60416090
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License Number State | WA
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