NPIMap

Organization Active NPI

Resurrection Adult Family Home LLC

  • Licensed Practical Nurse
  • Vancouver, WA
National Provider Identifier
1205707486
Registry record updated Sep 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
Legal business name
RESURRECTION ADULT FAMILY HOME LLC
Practice address
14824 NE 81St St
Vancouver, WA 98682-3406
Phone
(571) 665-9250
Fax
(360) 768-5289
NPI assigned
Sep 12, 2025
Organization subpart
Yes
Parent organization
RESURRECTION ADULT FAMILY HOME LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 12, 2025

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

Authorized official

Name
Mr. Abebe M GobezeNPI 1013625789
Title
Provider
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
Licensed Practical NurseGroup: 193400000X SINGLE SPECIALTY GROUP 164W00000X Primary

Addresses

Primary practice location

14824 NE 81St St
Vancouver, WA 98682-3406

Mailing address

14824 NE 81St St
Vancouver, WA 98682-3406
Phone (571) 665-9250

National Provider Directory

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

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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": "1757635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757635200000",
    "number": "1205707486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14824 NE 81ST ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986823406",
            "telephone_number": "571-665-9250",
            "fax_number": "360-768-5289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14824 NE 81ST ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986823406",
            "telephone_number": "571-665-9250",
            "fax_number": "360-768-5289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESURRECTION ADULT FAMILY HOME LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RESURRECTION ADULT FAMILY HOME LLC",
        "enumeration_date": "2025-09-12",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A",
        "authorized_official_last_name": "GOBEZE",
        "authorized_official_first_name": "ABEBE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "571-665-9250",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "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 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.