Organization
LOLLY ANGEL HOUSE AFH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER D MARTINEZ RN (OWNER)
(509) 901-4666
Entity
Organization
Contact information
Practice address
5704 DOUGLAS DR, YAKIMA, WA 98908-2732
(509) 901-4666
Mailing address
5704 DOUGLAS DR, YAKIMA, WA 98908-2732
(509) 901-4666
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2154431
—
WA
Enumeration date
05/05/2020
Last updated
05/05/2020
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