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General NPI Number Information
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NPI Number | 1518131036
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Entity Type | Organization
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Legal Business Name | HEAVENLY ACRES AFH INC.
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 27115 76TH AVE E
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City | GRAHAM
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State | WA
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Zip | 98338-7370
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Country | US
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Telephone | 253-846-5425
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Fax | 253-559-9990
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Provider Business Mailing Address
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Address Line | 27115 76TH AVE E
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City | GRAHAM
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State | WA
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Zip | 98338-7370
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Country | US
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Telephone | 253-846-5425
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Fax | 253-559-9990
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CHRISTINE ANGELIQUE SAYWERS
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Credential |
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Telephone | 253-846-5425
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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 | 366700
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License Number State | WA
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