Healthcare Provider Details

I. General information

NPI: 1083540991
Provider Name (Legal Business Name): HEART OF ANGELS ADULT FAMILY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11853 SE 323RD PL
AUBURN WA
98092-4808
US

IV. Provider business mailing address

11853 SE 323RD PL
AUBURN WA
98092-4808
US

V. Phone/Fax

Practice location:
  • Phone: 206-581-6788
  • Fax: 253-409-2425
Mailing address:
  • Phone: 206-581-6788
  • Fax: 253-409-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS LIDIYA ALEMU TIKU
Title or Position: PROVIDER
Credential: CNA
Phone: 206-356-8534