Individual provider · Type 1 NPI
Carol Anne Pettibone
Adult Care Home Facility · Walla Walla, WA
NPI number
1114704319
Active
Practice location
1840 Gray Lynn Dr
Walla Walla, WA 99362-9247
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Care Home Facility Primary | 311ZA0620X | 310601 (WA) |
Adult Care Home Facility: 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.
About NPI 1114704319
Carol Anne Pettibone's National Provider Identifier is 1114704319, issued on Sep 11, 2023. The primary taxonomy on file is Adult Care Home Facility (311ZA0620X), and the practice location is in Walla Walla, WA. The record was last updated on Sep 11, 2023.