Healthcare Provider Details

I. General information

NPI: 1437075702
Provider Name (Legal Business Name): EDWARD MACHARIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDWARD MACHARIA

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36202 24TH PL S
FEDERAL WAY WA
98003-7159
US

IV. Provider business mailing address

36202 24TH PL S
FEDERAL WAY WA
98003-7159
US

V. Phone/Fax

Practice location:
  • Phone: 253-266-9759
  • Fax: 253-517-8394
Mailing address:
  • Phone: 253-266-9759
  • Fax: 253-515-8394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number753044
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: