Healthcare Provider Details

I. General information

NPI: 1902726599
Provider Name (Legal Business Name): SENIOR VILLAGE ADULT FAMILY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 177TH AVE NE
BELLEVUE WA
98008-3408
US

IV. Provider business mailing address

931 177TH AVE NE
BELLEVUE WA
98008-3408
US

V. Phone/Fax

Practice location:
  • Phone: 425-625-1604
  • Fax: 425-590-9881
Mailing address:
  • Phone: 425-625-1604
  • Fax: 425-590-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MISS BOBBETTE KERR
Title or Position: PROVIDER/ADMINISTRATOR
Credential: CNA
Phone: 425-625-1604