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General NPI Number Information
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NPI Number | 1821812587
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Entity Type | Organization
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Legal Business Name | CLOVERSTONE ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1829 W MISSION AVE UNIT A
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City | SPOKANE
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State | WA
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Zip | 99201-2837
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Country | US
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Telephone | 414-698-4649
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Fax |
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Provider Business Mailing Address
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Address Line | 1829 W MISSION AVE UNIT A
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City | SPOKANE
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State | WA
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Zip | 99201-2837
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Country | US
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Telephone | 414-698-4649
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATION MANAGER
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Name | EBONY JAITEH
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Credential | HOME CARE AIDE
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Telephone | 414-698-4649
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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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