Provider Demographics
NPI:1881342376
Name:AVIAN ADULT FAMILY HOME B LLC
Entity type:Organization
Organization Name:AVIAN ADULT FAMILY HOME B LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:NDIRITU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-341-8755
Mailing Address - Street 1:7217 91ST AVENUE CT SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-7100
Mailing Address - Country:US
Mailing Address - Phone:253-341-8755
Mailing Address - Fax:
Practice Address - Street 1:1115 144TH ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-2583
Practice Address - Country:US
Practice Address - Phone:253-341-8755
Practice Address - Fax:253-409-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2068817Medicaid