Healthcare Provider Details

I. General information

NPI: 1124965181
Provider Name (Legal Business Name): AKIEM DELANO FORBES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 COLEBROOKE LN SE
LACEY WA
98513-2239
US

IV. Provider business mailing address

4401 COLEBROOKE LN SE
LACEY WA
98513-2239
US

V. Phone/Fax

Practice location:
  • Phone: 564-263-1122
  • Fax:
Mailing address:
  • Phone: 564-263-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number758834
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: