Healthcare Provider Details

I. General information

NPI: 1114840162
Provider Name (Legal Business Name): KENBE AFH 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

426 RHODORA HEIGHTS RD
LAKE STEVENS WA
98258-9786
US

IV. Provider business mailing address

426 RHODORA HEIGHTS RD
LAKE STEVENS WA
98258-9786
US

V. Phone/Fax

Practice location:
  • Phone: 731-325-0519
  • Fax: 360-294-7825
Mailing address:
  • Phone: 731-325-0519
  • Fax: 360-294-7825

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: BEATRICE NASIMIYU KHISA
Title or Position: PROVIDER
Credential:
Phone: 731-325-0519