Provider Demographics
NPI:1649141441
Name:FAHARI ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:FAHARI ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMOYE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-339-9070
Mailing Address - Street 1:403 N HAUSER AVE
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-9444
Mailing Address - Country:US
Mailing Address - Phone:509-288-0547
Mailing Address - Fax:509-288-4932
Practice Address - Street 1:935 SE KAMIAKEN ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2233
Practice Address - Country:US
Practice Address - Phone:509-338-3006
Practice Address - Fax:509-288-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty