Provider Demographics
NPI:1588544886
Name:GLENHAVEN ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:GLENHAVEN ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:MILANOI
Authorized Official - Last Name:SHOMPOLE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:509-432-1169
Mailing Address - Street 1:PO BOX 1167
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-1167
Mailing Address - Country:US
Mailing Address - Phone:509-432-1169
Mailing Address - Fax:509-338-0595
Practice Address - Street 1:2510 NW PARR DR
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3686
Practice Address - Country:US
Practice Address - Phone:509-432-1169
Practice Address - Fax:509-338-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health