Organization
DIVINITY ADULT FAMILY HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER LEE JACOBS R.N. (CEO/RN)
(360) 518-9998
Entity
Organization
Contact information
Practice address
5902 KANSAS ST, VANCOUVER, WA 98661-6918
(360) 518-9998
Mailing address
38718 NE CHRISTENSEN RD, LA CENTER, WA 98629-4731
(360) 518-9998
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
RN60100368
WA
Other
Enumeration date
09/02/2014
Last updated
09/02/2014
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