Healthcare Provider Details

I. General information

NPI: 1932045317
Provider Name (Legal Business Name): KELEMWA H MENEGESHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34259 36TH PL SW
FEDERAL WAY WA
98023-2941
US

IV. Provider business mailing address

34259 36TH PL SW
FEDERAL WAY WA
98023-2941
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-8490
  • Fax: 253-235-5780
Mailing address:
  • Phone: 206-302-8490
  • Fax: 253-235-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number758241
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: