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General NPI Number Information
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NPI Number | 1538746490
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Entity Type | Organization
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Legal Business Name | LEGACY AFH LLC
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 17702 NE 31ST ST
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City | VANCOUVER
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State | WA
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Zip | 98682-3694
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Country | US
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Telephone | 660-619-1055
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Fax |
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Provider Business Mailing Address
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Address Line | 17702 NE 31ST ST
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City | VANCOUVER
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State | WA
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Zip | 98682-3694
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Country | US
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Telephone | 660-619-1055
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOFEY SHEVCHENKO
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Credential | RN
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Telephone | 660-619-1055
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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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