Provider Demographics
NPI:1477720589
Name:ANSARA FAMILY HOME LLC
Entity Type:Organization
Organization Name:ANSARA FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANSARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-857-6566
Mailing Address - Street 1:8225 59TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6261
Mailing Address - Country:US
Mailing Address - Phone:253-857-6566
Mailing Address - Fax:
Practice Address - Street 1:424 174TH PL NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-4245
Practice Address - Country:US
Practice Address - Phone:425-562-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA750183311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home