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Carol Anne Pettibone
Adult Care Home Facility in Walla Walla, Washington
NPI 1114704319

Carol Anne Pettibone is an Adult Care Home Facility based in Walla Walla, WA and is specialized in Adult Care Home. Carol Anne Pettibone practices in Walla Walla, WA. The NPI Number for Carol Anne Pettibone is 1114704319 and holds a License No. 310601 (Washington).

The current practice location address for Carol Anne Pettibone is 1840 Gray Lynn Dr, Walla Walla, WA and can be reached out via phone at 509-529-3447.

Location: 1840 Gray Lynn Dr, Walla Walla, WA, 99362-9247
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1114704319
Provider Name
Carol Anne Pettibone
Credential
Provider Entity Type
Individual
Gender
Female
Address
1840 Gray Lynn Dr, Walla Walla, WA, 99362-9247
Phone Number
509-529-3447
Fax Number
Provider Enumeration Date
09/11/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1840 Gray Lynn Dr
City
Walla Walla
State
Washington
Zip
99362-9247
Phone Number
509-529-3447
Fax Number
person
Provider Business Mailing Address Details
Address
1840 Gray Lynn Dr
City
Walla Walla
State
Washington
Zip
99362-9247
Phone Number
509-529-3447
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Custodial Care Facility
Speciality
Adult Care Home
Taxonomy
311ZA0620X
License No.
310601 (Washington)
Definition
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.
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