Provider Demographics
NPI:1598636920
Name:ANGELS WING ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:ANGELS WING ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EPETI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:831-747-4130
Mailing Address - Street 1:PO BOX 48727
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-1727
Mailing Address - Country:US
Mailing Address - Phone:831-747-4130
Mailing Address - Fax:509-418-2092
Practice Address - Street 1:4718 N BOLIVAR CT
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:831-747-4130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home