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General NPI Number Information
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NPI Number | 1912889460
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Entity Type | Organization
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Legal Business Name | THE QUEENS ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 424 W BUCKEYE AVE
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City | SPOKANE
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State | WA
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Zip | 99205-3275
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Country | US
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Telephone | 208-217-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 424 W BUCKEYE AVE
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City | SPOKANE
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State | WA
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Zip | 99205-3275
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Country | US
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Telephone | 208-217-6333
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | NAHRAWAN GATEA KHUDHAIR
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Credential |
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Telephone | 208-217-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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