Healthcare Provider Details

I. General information

NPI: 1013655331
Provider Name (Legal Business Name): KELLEY CARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/28/2022
Certification Date: 05/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19736 40TH CT NE
LAKE FOREST PARK WA
98155-1604
US

IV. Provider business mailing address

19736 40TH CT NE
LAKE FOREST PARK WA
98155-1604
US

V. Phone/Fax

Practice location:
  • Phone: 206-715-1677
  • Fax:
Mailing address:
  • Phone: 206-715-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KELLEY CONFER
Title or Position: OWNER
Credential: RN
Phone: 206-715-1677