Healthcare Provider Details

I. General information

NPI: 1992636609
Provider Name (Legal Business Name): DUVALL HILLS ADULT FAMILY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27710 NE 142ND PL
DUVALL WA
98019-8397
US

IV. Provider business mailing address

27710 NE 142ND PL
DUVALL WA
98019-8397
US

V. Phone/Fax

Practice location:
  • Phone: 425-318-6038
  • Fax: 425-577-6530
Mailing address:
  • Phone: 425-318-6038
  • Fax: 425-577-6530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL WEGGE BUSHEBI
Title or Position: PROVIDER
Credential: HCA
Phone: 682-553-0233