Provider Demographics
NPI:1639577984
Name:ARCADIA ADULT FAMILY HOME, LLC
Entity Type:Organization
Organization Name:ARCADIA ADULT FAMILY HOME, LLC
Other - Org Name:ARCADIA HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMIRNOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-739-8859
Mailing Address - Street 1:910 38TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-3158
Mailing Address - Country:US
Mailing Address - Phone:360-752-1655
Mailing Address - Fax:360-756-0840
Practice Address - Street 1:910 38TH ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-3158
Practice Address - Country:US
Practice Address - Phone:360-752-1655
Practice Address - Fax:360-756-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA694000313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA449929OtherSOCIAL SERVICE PAYMENT SYSTEM (SSPS)
WA449929Medicaid