=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376110692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLYS CARING ADULT FAMILY HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2021
-----------------------------------------------------
Last Update Date | 06/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11920 N STEVENS CT
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99218-2839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-474-1332
-----------------------------------------------------
Fax | 509-474-9359
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11920 N STEVENS CT
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99218-2839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-474-1332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/OWNER
-----------------------------------------------------
Name | MONICAH NDIRANGU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-474-1332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------