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Organization
MIRANDA CARE ADULT FAMILY HOME
Active
Organization
MIRANDA CARE ADULT FAMILY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE CHRISTINE REESE RN (REGISTERED NURSE OWNER)
(509) 952-5564
Entity
Organization
Contact information
Practice address
601 N 39TH ST, YAKIMA, WA 98901-1222
(509) 577-0423
(509) 577-0635
Mailing address
601 N 39TH ST, YAKIMA, WA 98901-1222
(509) 577-0423
(509) 577-0635
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
A208501
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311ZA0620X
ADULT CARE HOME
WA
Enumeration date
03/16/2008
Last updated
03/16/2008
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