Angela's Adult Family Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

648700 Issued in WA

Legal business name

ANGELA'S ADULT FAMILY HOME

Practice address

26308 185TH Ave SE
Covington, WA 98042-8425

Phone

(253) 638-8338

Fax

(253) 631-6871

NPI assigned

May 21, 2008

Last updated

May 21, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Angela Dee Iverson, C.N.A.

Title

Owner/ Provider

Phone

(253) 638-8338

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1578720157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26308 185TH AVE SE",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980428425",
            "telephone_number": "253-638-8338",
            "fax_number": "253-631-6871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26308 185TH AVE SE",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980428425",
            "telephone_number": "253-638-8338",
            "fax_number": "253-631-6871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELA'S ADULT FAMILY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "IVERSON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "OWNER/ PROVIDER",
        "authorized_official_telephone_number": "253-638-8338",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "C.N.A."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "WA",
            "license": "648700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.