NPIMap

Organization Active NPI

Resurrection Adult Family Home LLC

  • Home Health Agency
  • Vancouver, WA
National Provider Identifier
1013629237
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
RESURRECTION ADULT FAMILY HOME LLC
Practice address
10800 NE 109TH Ave
Vancouver, WA 98662-3371
Phone
(360) 258-0698
NPI assigned
Dec 19, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Abebe GobezeNPI 1013625789
Title
Director
Phone
(571) 665-9250

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

10800 NE 109TH Ave
Vancouver, WA 98662-3371

Mailing address

10800 NE 109TH Ave
Vancouver, WA 98662-3371
Phone (360) 258-0698

Other practice location 1

10800 NE 109th Ave
Vancouver, WA 98662-3371
Phone (360) 258-0698

Other practice location 2

14824 NE 81st St
Vancouver, WA 98682-3406
Phone (360) 768-5494

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2294161Resurrection Adult Family Home LLC10800 NE 109TH Ave, Vancouver, WA 98662Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Resurrection Adult Family Home LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758067200000",
    "number": "1013629237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 NE 109TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986623371",
            "telephone_number": "360-258-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 NE 109TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986623371",
            "telephone_number": "360-258-0698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10800 NE 109th Ave",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986623371",
            "country_code": "US",
            "telephone_number": "360-258-0698",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14824 NE 81st St",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986823406",
            "country_code": "US",
            "telephone_number": "360-768-5494",
            "fax_number": "360-768-5289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RESURRECTION ADULT FAMILY HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-19",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A",
        "authorized_official_last_name": "GOBEZE",
        "authorized_official_first_name": "ABEBE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "571-665-9250"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.