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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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