Healthcare Provider Details

I. General information

NPI: 1407761760
Provider Name (Legal Business Name): HAVEN OF LOVE ADULT FAMILY HOME 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 S RAINIER ST
KENNEWICK WA
99337-3843
US

IV. Provider business mailing address

3206 S RAINIER ST
KENNEWICK WA
99337-3843
US

V. Phone/Fax

Practice location:
  • Phone: 509-396-3474
  • Fax:
Mailing address:
  • Phone: 509-396-3474
  • 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: JAMES MBUTHIA
Title or Position: OWNER
Credential:
Phone: 206-960-3072