DIVINITY ADULT FAMILY HOME LLC NPI 1568862134

NPI Information

  • NPI: 1568862134
  • Provider Name: DIVINITY ADULT FAMILY HOME, LLC
  • Classification: Custodial Care Facility - 311ZA0620X
  • Specialization: Adult Care Home
  • Entity Type: Organization
  • Address: 5902 KANSAS ST
    VANCOUVER, WA
    ZIP 98661
  • Phone: (360) 518-9998

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NPI Details

DIVINITY ADULT FAMILY HOME, LLC is an adult care home custodial care facility in Vancouver, WA. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. DIVINITY ADULT FAMILY HOME, LLC NPI is 1568862134. The provider is registered as an organization entity type.

The provider's business location address is:

5902 KANSAS ST
VANCOUVER, WA
ZIP 98661-918
Phone: (360) 518-9998

The provider's authorized official is Amber Lee Jacobs .
The authorized official title is Ceo/rn and has the following contact phone number (360) 518-9998.

The enumeration date for this NPI number is 9/2/2014 and was last updated on 9/2/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1311ZA0620XCustodial Care FacilityAdult Care HomeRN60100368WASHINGTONYes

What is NPI?

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This page was last updated on: 3/30/2025

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