Blueberry Hills Adult Family Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

BLUEBERRY HILLS ADULT FAMILY HOME

Doing business as

Grace Land Adult Family Home

Practice address

20613 NE 176TH Ave
Battle Ground, WA 98604-3608

Phone

(360) 687-4433

Fax

(360) 687-9113

NPI assigned

Mar 19, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Fe Pangan Cava

Title

Owner

Phone

(360) 687-4433

Specialties & licenses 1

Addresses

Other names 1

• Grace Land Adult Family Home Doing business as

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205884800000",
    "number": "1306017124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20613 NE 176TH AVE",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986043608",
            "telephone_number": "360-687-4433",
            "fax_number": "360-687-9113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20613 NE 176TH AVE",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986043608",
            "telephone_number": "360-687-4433",
            "fax_number": "360-687-9113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEBERRY HILLS ADULT FAMILY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2008-03-19",
        "status": "A",
        "authorized_official_last_name": "CAVA",
        "authorized_official_first_name": "FE",
        "authorized_official_middle_name": "PANGAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-687-4433",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grace Land Adult Family Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in Battle Ground, WA
• Providers in Battle Ground, WA by specialty
• Adult Care Home Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; 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.