Healthcare Provider Details

I. General information

NPI: 1164345112
Provider Name (Legal Business Name): HUMILITY ADULT FAMILY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4628 KENT CT
KENT WA
98032-7112
US

IV. Provider business mailing address

4628 KENT CT
KENT WA
98032-7112
US

V. Phone/Fax

Practice location:
  • Phone: 206-786-2386
  • Fax: 206-385-2203
Mailing address:
  • Phone: 206-786-2386
  • Fax: 206-385-2203

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: ASGEDOM H WOLDTEKLE
Title or Position: PROVIDER
Credential: RN
Phone: 206-786-2386