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General NPI Number Information
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NPI Number | 1598636920
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Entity Type | Organization
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Legal Business Name | ANGELS WING ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 4718 N BOLIVAR CT
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216
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Country | US
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Telephone | 831-747-4130
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 48727
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City | SPOKANE
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State | WA
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Zip | 99228-1727
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Country | US
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Telephone | 831-747-4130
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Fax | 509-418-2092
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | EPETI BRANDAU
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Credential | CNA
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Telephone | 831-747-4130
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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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