# CLOVERSTONE ADULT FAMILY HOME LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821812587
- **Authorized official:** EBONY JAITEH HOME CARE AIDE (OWNER/ADMINISTRATION MANAGER)
- **Authorized official phone:** (414) 698-4649

## Contact information

- **Practice address:** 1829 W MISSION AVE UNIT A, SPOKANE, WA 99201-2837
- **Practice address phone:** (414) 698-4649
- **Mailing address:** 1829 W MISSION AVE UNIT A, SPOKANE, WA 99201-2837
- **Mailing address phone:** (414) 698-4649

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/11/2024
- **Last updated:** 11/11/2024