Provider Demographics
NPI:1174497069
Name:EDDY ADULT FAMILY HOME
Entity type:Organization
Organization Name:EDDY ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:NYAKIO
Authorized Official - Last Name:NGANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-564-0705
Mailing Address - Street 1:7613 JADE DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4833
Mailing Address - Country:US
Mailing Address - Phone:914-564-0705
Mailing Address - Fax:253-267-5616
Practice Address - Street 1:7613 JADE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4833
Practice Address - Country:US
Practice Address - Phone:914-564-0705
Practice Address - Fax:253-267-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home