Provider Demographics
NPI:1184335101
Name:JAHAY, COURTNEY JANE (NAR)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JANE
Last Name:JAHAY
Suffix:
Gender:F
Credentials:NAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10717 N SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6403
Mailing Address - Country:US
Mailing Address - Phone:509-944-5345
Mailing Address - Fax:509-290-6464
Practice Address - Street 1:10717 N SKYLINE DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6403
Practice Address - Country:US
Practice Address - Phone:509-944-5345
Practice Address - Fax:509-290-6464
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA755295311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2200995Medicaid