Healthcare Provider Details

I. General information

NPI: 1245140250
Provider Name (Legal Business Name): GREEN VALLEY AFH #2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 SE 212TH ST
KENT WA
98031-2151
US

IV. Provider business mailing address

11350 SE 212TH ST
KENT WA
98031-2151
US

V. Phone/Fax

Practice location:
  • Phone: 206-551-5264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ALEMTSEHAY MENGESTU
Title or Position: AFH PROVIDED
Credential:
Phone: 206-551-5264