Provider Demographics
NPI:1801234877
Name:ROSIE'S ADULT FAMILY HOME
Entity type:Organization
Organization Name:ROSIE'S ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-734-0851
Mailing Address - Street 1:611 N YOST ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6171
Mailing Address - Country:US
Mailing Address - Phone:509-734-0851
Mailing Address - Fax:509-734-1071
Practice Address - Street 1:611 N YOST ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6171
Practice Address - Country:US
Practice Address - Phone:509-734-0851
Practice Address - Fax:509-734-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
523900311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA311ZA0620XMedicaid