Healthcare Provider Details

I. General information

NPI: 1144151184
Provider Name (Legal Business Name): PEACEFUL HAVEN LEGACY AFH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 116TH ST SW
EVERETT WA
98204-4849
US

IV. Provider business mailing address

807 116TH ST SW
EVERETT WA
98204-4849
US

V. Phone/Fax

Practice location:
  • Phone: 206-251-6779
  • Fax: 231-751-2099
Mailing address:
  • Phone: 206-251-6779
  • Fax: 231-751-2099

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: MESFIN GETNET
Title or Position: PROVIDER
Credential:
Phone: 206-251-6779