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General NPI Number Information
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NPI Number | 1558153023
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Entity Type | Organization
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Legal Business Name | NW SERENITY ADULT FAMILY HOME
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 7418 SE EVERGREEN HWY
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City | VANCOUVER
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State | WA
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Zip | 98664-1718
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Country | US
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Telephone | 564-258-9740
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Fax |
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Provider Business Mailing Address
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Address Line | 1407 SE 196TH AVE
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City | CAMAS
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State | WA
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Zip | 98607-9547
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Country | US
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Telephone | 360-513-5987
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. RAMINTA BARRADALE
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Credential | HOME CARE AIDE
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Telephone | 360-513-5987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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