Healthcare Provider Details

I. General information

NPI: 1083535660
Provider Name (Legal Business Name): WUDIYE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 OCEAN AVE
EVERETT WA
98203-1309
US

IV. Provider business mailing address

5502 OCEAN AVE
EVERETT WA
98203-1309
US

V. Phone/Fax

Practice location:
  • Phone: 206-850-9539
  • Fax: 425-595-6737
Mailing address:
  • Phone: 206-850-9539
  • Fax: 425-595-6737

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: TEDLA MENGESHA WOLDEMARIAM
Title or Position: PROVIDER
Credential:
Phone: 206-850-9539