Healthcare Provider Details

I. General information

NPI: 1760311005
Provider Name (Legal Business Name): GOLDEN PARK LANE AFH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34628 14TH PL SW
FEDERAL WAY WA
98023-7038
US

IV. Provider business mailing address

34628 14TH PL SW
FEDERAL WAY WA
98023-7038
US

V. Phone/Fax

Practice location:
  • Phone: 763-291-2694
  • Fax:
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: MARTIN GITAU
Title or Position: MANAGER
Credential:
Phone: 763-291-2694