Organization
LEGACY AFH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOFEY SHEVCHENKO RN (OWNER)
(660) 619-1055
Entity
Organization
Contact information
Practice address
17702 NE 31ST ST, VANCOUVER, WA 98682-3694
(660) 619-1055
Mailing address
17702 NE 31ST ST, VANCOUVER, WA 98682-3694
(660) 619-1055
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902483217
—
WA
Enumeration date
03/26/2021
Last updated
03/26/2021
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