Healthcare Provider Details

I. General information

NPI: 1922824424
Provider Name (Legal Business Name): CUIDADO B ADULT FAMILY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15706 253RD ST E
GRAHAM WA
98338-8654
US

IV. Provider business mailing address

15706 253RD ST E
GRAHAM WA
98338-8654
US

V. Phone/Fax

Practice location:
  • Phone: 206-531-9627
  • Fax:
Mailing address:
  • Phone: 206-531-9627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCIS KIBIKO MUNGAI
Title or Position: PROVIDER
Credential:
Phone: 206-531-9627