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General NPI Number Information
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NPI Number | 1801747472
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Entity Type | Organization
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Legal Business Name | ST. MARY ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 1114 E BRIERWOOD DR
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City | SPOKANE
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State | WA
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Zip | 99218-1718
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Country | US
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Telephone | 206-734-2830
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Fax |
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Provider Business Mailing Address
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Address Line | 1114 E BRIERWOOD DR
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City | SPOKANE
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State | WA
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Zip | 99218-1718
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Country | US
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Telephone | 206-734-2830
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEHARENA BERHE ZERESENAI
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Credential | RN
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Telephone | 206-734-2830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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