Organization
DIVINITY ADULT FAMILY HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER LEE JACOBS R.N. (OWNER)
(360) 518-9998
Entity
Organization
Contact information
Practice address
38718 NE CHRISTENSEN RD, LA CENTER, WA 98629-4731
(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
201140065RN
WA
Other
Enumeration date
10/26/2014
Last updated
10/26/2014
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