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General NPI Number Information
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NPI Number | 1629785159
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Entity Type | Organization
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Legal Business Name | SUNDANCE ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 10216 N SUNDANCE DR
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City | SPOKANE
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State | WA
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Zip | 99208-9315
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Country | US
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Telephone | 509-315-5779
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Fax | 509-984-6291
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Provider Business Mailing Address
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Address Line | 10216 N SUNDANCE DR
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City | SPOKANE
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State | WA
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Zip | 99208-9315
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Country | US
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Telephone | 509-315-5779
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Fax | 509-984-6291
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Authorized Official
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Title or Position | MANAGER
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Name | MS. SUSAN MWIKLAI WAWERU
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Credential | RN
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Telephone | 508-612-3875
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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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