Provider Demographics
NPI:1124563697
Name:HIGH DRIVE ADULT FAMILY HOME
Entity Type:Organization
Organization Name:HIGH DRIVE ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGATIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-262-3858
Mailing Address - Street 1:119 E HIGH DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2756
Mailing Address - Country:US
Mailing Address - Phone:509-263-5851
Mailing Address - Fax:509-747-2155
Practice Address - Street 1:119 E HIGH DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2756
Practice Address - Country:US
Practice Address - Phone:774-262-3858
Practice Address - Fax:509-747-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA752761311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home