Basic Information
| Provider Information | |||||||||
| NPI: | 1689206484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENRY | ||||||||
| FirstName: | ALAJAH | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 E COZZA DR | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992086514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093256800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 44 E COZZA DR | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992086514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093256800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2020 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | NC60621562 | WA | Y | Nursing Service Related Providers | Nurse's Aide |
ID Information
| ID | Type | State | Issuer | Description | 2077844 | 05 | WA | MEDICAID |