MIRANDA CARE ADULT FAMILY HOME (NPI# 1528239753) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528239753 |
| Entity Type | Organization |
| Organization Name | MIRANDA CARE ADULT FAMILY HOME |
| Practice Address |
601 N 39th St Yakima WA 98901-1222 |
| Practice Telephone | 5095770423 |
| Practice Fax Number | 5095770635 |
| Mailing Telephone | 5095770423 |
| Mailing Fax Number | 5095770635 |
| Enumeration Date | 2008-03-16 |
| Last Update Date | 2008-03-16 |
| Authorized Official Name | NICOLE CHRISTINE REESE (REGISTERED NURSE OWNER) |
| Authorized Official Telephone | 5099525564 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311Z00000X | Custodial Care Facility | A208501 | WA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | ADULT CARE HOME | 311ZA0620X | 01 |
| Street Address |
601 N 39TH ST |
| City | YAKIMA |
| State | WA |
| Zip Code | 98901-1222 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609316645 | Tyler Reese | Student in an Organized Health Care Education/Training Program | 601 N 39th St, Yakima, WA 98901-1222 | 2017-02-23 |
| 1700326741 | Christopher Michael Reese | Student in an Organized Health Care Education/Training Program | 601 N 39th St, Yakima, WA 98901-1222 | 2017-02-23 |
| 1770744310 | Nicole Christine Reese | Registered Nurse | 601 N 39th St, Yakima, WA 98901-1222 | 2008-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162998 | China Nwachukwu | Pharmacist | Buter-haney Hall, 200 University Pkwy, Yakima, WA 98901 | 2020-07-30 |
| 1760959290 | Conswaylo Ann Fleek | Counselor | 120 S. 3rd Ave., Yakima, WA 98901 | 2018-11-02 |
| 1396212718 | Nancy Fraser | Counselor | 120 S. 3rd Street, Yakima, WA 98901 | 2018-10-24 |
| 1386129021 | John Scott | Student in an Organized Health Care Education/Training Program | Pacific Northwest University of Health Sciences, 111 University Parkway, Suite 202, Yakima, WA 98901 | 2018-09-28 |
| 1679051387 | Toni Christine Fogli | Counselor | 2280 Ste. Rte. 821, Yakima, WA 98901 | 2018-08-03 |
| 1043798267 | Amber Ann Couture | Counselor | 2280 Wa-821, Yakima, WA 98901 | 2018-07-31 |
| 1992201982 | Etienne Galbreath | Student in an Organized Health Care Education/Training Program | Butler-haney Hall, 200 University Pkwy, Yakima, WA 98901 | 2018-03-30 |
| 1619490737 | Christine M Armijo | Massage Therapist | 1001 University Parkway, Yakima, WA 98901 | 2017-07-20 |
| 1366970048 | Jose Antonio Mendoza | Dentist | 12 S 8t Hst, Yakima, WA 98901 | 2017-05-25 |
| 1982156501 | David Burkett | Counselor | 315 N. 2nd Street, Yakima, WA 98901 | 2016-10-31 |
| Find all providers in zip 98901 | ||||
| Taxonomy Code | 311Z00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| A facility providing care that serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, and using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered. Custodial care essentially is personal care that does not require the continuing attention of trained medical or paramedical personnel. |
| Notes: Source: Paraphrased from Section 3159 A3 of the Medicare Intermediary Manual. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215380803 | Ryan Owens | Custodial Care Facility | 120 Se Everett Mall Way, Apt 1217, Everett, WA 98208-3204 | 2016-07-19 |
| 1356795652 | William L. Whiteman | Custodial Care Facility | 7811 144th Street Ct E, C/o Jennifer Brantley, Puyallup, WA 98375-8404 | 2016-04-22 |
| 1255607198 | Sherwood Adult Family Home, LLC | Custodial Care Facility | 11017 Ne Sherwood Drive, Vancouver, WA 98686 | 2012-03-26 |
| 1699828103 | P.c. Jail Clinic | Custodial Care Facility | 910 Tacoma Ave S, Tacoma, WA 98402-2104 | 2007-01-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.