Provider Demographics
NPI:1780408112
Name:NDERITU, GEORGE MUHORO
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MUHORO
Last Name:NDERITU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 N MARINGO DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1865
Mailing Address - Country:US
Mailing Address - Phone:509-592-3579
Mailing Address - Fax:509-924-2756
Practice Address - Street 1:4217 N MARINGO DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99212-1865
Practice Address - Country:US
Practice Address - Phone:509-592-3579
Practice Address - Fax:509-924-2756
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA754022311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home