Organization
COUNTRY LIVING ADULT FAMILY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ERMELINDA V KNUPP (ADULT FAM HOME PROVIDER)
(253) 875-6663
Entity
Organization
Contact information
Practice address
21514 47TH AVE E, SPANAWAY, WA 98387
(253) 875-6663
(253) 875-6663
Mailing address
21514 47TH AVE E, SPANAWAY, WA 98387
(253) 875-6663
(253) 875-6663
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
750777
WA
Other
Enumeration date
04/24/2008
Last updated
04/24/2008
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