Provider Demographics
NPI:1760887830
Name:FOREST PARK ADULT FAMILY HOME INC
Entity Type:Organization
Organization Name:FOREST PARK ADULT FAMILY HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHAILA
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:253-833-4815
Mailing Address - Street 1:17522 SE 338TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-5212
Mailing Address - Country:US
Mailing Address - Phone:253-833-4815
Mailing Address - Fax:
Practice Address - Street 1:17522 SE 338TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-5212
Practice Address - Country:US
Practice Address - Phone:253-833-4815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA752403311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA279683Medicaid