Country Living Adult Family Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

750777 Issued in WA

Legal business name

COUNTRY LIVING ADULT FAMILY HOME

Practice address

21514 47TH Ave E
Spanaway, WA 98387

Phone

(253) 875-6663

Fax

(253) 875-6663

NPI assigned

Apr 24, 2008

Last updated

Apr 24, 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. Ermelinda V Knupp

Title

Adult Fam Home Provider

Phone

(253) 875-6663

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1780859330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21514 47TH AVE E",
            "city": "SPANAWAY",
            "state": "WA",
            "postal_code": "98387",
            "telephone_number": "253-875-6663",
            "fax_number": "253-875-6663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21514 47TH AVE E",
            "city": "SPANAWAY",
            "state": "WA",
            "postal_code": "98387",
            "telephone_number": "253-875-6663",
            "fax_number": "253-875-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY LIVING ADULT FAMILY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "KNUPP",
        "authorized_official_first_name": "ERMELINDA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "ADULT FAM HOME PROVIDER",
        "authorized_official_telephone_number": "253-875-6663",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "WA",
            "license": "750777",
            "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 Apr 24, 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.