Provider Demographics
NPI:1558917674
Name:HOPE OF LIFE ADULT FAMILY HOME
Entity Type:Organization
Organization Name:HOPE OF LIFE ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEZENGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-596-6742
Mailing Address - Street 1:12314 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0323
Mailing Address - Country:US
Mailing Address - Phone:509-474-0168
Mailing Address - Fax:509-474-0178
Practice Address - Street 1:12402 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0323
Practice Address - Country:US
Practice Address - Phone:206-596-6742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty