| Organization Name: | DIVINITY ADULT FAMILY HOME, LLC |
| NPI Number: | 1598160186 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMBER LEE JACOBS (OWNER) |
| Mailing Address: | 38718 Ne Christensen Rd La Center |
| State: | WA US |
| Postal Code: | 986294731 |
| Phone Number: | 3605189998 |
| Fax Number: | |
| NPI Enumeration Date: | 10/26/2014 |
| NPI Last Update Date: | 10/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 311ZA0620X |
| License Number: | 201140065RN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Custodial Care Facility |
| Taxonomy Specialization: | Adult Care Home |
| Taxonomy Definition: | 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. |