Healthcare Provider Details

I. General information

NPI: 1235986845
Provider Name (Legal Business Name): BUENA VISTA AFH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 FOREST RIDGE DR SE
AUBURN WA
98002-7023
US

IV. Provider business mailing address

2605 FOREST RIDGE DR SE
AUBURN WA
98002-7023
US

V. Phone/Fax

Practice location:
  • Phone: 206-413-1955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: BENARD KALAMA
Title or Position: ADULT CARE HOME ADMINISTRATOR
Credential:
Phone: 206-413-1955