Healthcare Provider Details

I. General information

NPI: 1386556744
Provider Name (Legal Business Name): HOUSE OF ELITE ADULT FAMILY HOME 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S 259TH ST
DES MOINES WA
98198-9043
US

IV. Provider business mailing address

1901 S 259TH ST
DES MOINES WA
98198-9043
US

V. Phone/Fax

Practice location:
  • Phone: 206-261-6152
  • Fax: 425-984-0552
Mailing address:
  • Phone: 206-261-6152
  • Fax: 425-984-0552

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: JAZMINE DEVANTIER
Title or Position: ADMINISTRATOR
Credential:
Phone: 206-261-6152