Provider Demographics
NPI:1578720157
Name:ANGELA'S ADULT FAMILY HOME
Entity Type:Organization
Organization Name:ANGELA'S ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:253-638-8338
Mailing Address - Street 1:26308 185TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8425
Mailing Address - Country:US
Mailing Address - Phone:253-638-8338
Mailing Address - Fax:253-631-6871
Practice Address - Street 1:26308 185TH AVE SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-8425
Practice Address - Country:US
Practice Address - Phone:253-638-8338
Practice Address - Fax:253-631-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA648700311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home