Provider Demographics
NPI:1669364162
Name:LAVENDER LANE ADULT FAMILY HOME
Entity type:Organization
Organization Name:LAVENDER LANE ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:G
Authorized Official - Last Name:DE LA FORCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-850-7442
Mailing Address - Street 1:6805 N BELT ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4301
Mailing Address - Country:US
Mailing Address - Phone:509-850-7442
Mailing Address - Fax:
Practice Address - Street 1:9616 N SYLVIA CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8632
Practice Address - Country:US
Practice Address - Phone:509-850-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home