Healthcare Provider Details

I. General information

NPI: 1710815063
Provider Name (Legal Business Name): 1ST MICHAEL ADULT FAMILY HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12710 20TH PL W
EVERETT WA
98204-5583
US

IV. Provider business mailing address

12710 20TH PL W
EVERETT WA
98204-5583
US

V. Phone/Fax

Practice location:
  • Phone: 206-349-2285
  • Fax: 425-484-8001
Mailing address:
  • Phone:
  • Fax:

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: TESFAYE B NORAHUN
Title or Position: OWNER
Credential:
Phone: 206-349-2285