Provider Demographics
NPI:1174964928
Name:GREEN HOUSE ADULT FAMILY HOME, INC.
Entity type:Organization
Organization Name:GREEN HOUSE ADULT FAMILY HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:NAR
Authorized Official - Phone:509-535-2005
Mailing Address - Street 1:2304 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4170
Mailing Address - Country:US
Mailing Address - Phone:509-535-2005
Mailing Address - Fax:509-536-7854
Practice Address - Street 1:2304 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4170
Practice Address - Country:US
Practice Address - Phone:509-535-2005
Practice Address - Fax:509-536-7854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA751172311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home