Healthcare Provider Details

I. General information

NPI: 1265127435
Provider Name (Legal Business Name): HODAN FARAH RAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 S 228TH PL
KENT WA
98031-2559
US

IV. Provider business mailing address

9921 S 228TH PL
KENT WA
98031-2559
US

V. Phone/Fax

Practice location:
  • Phone: 206-861-3232
  • Fax:
Mailing address:
  • Phone: 206-861-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number60265800
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: