Healthcare Provider Details

I. General information

NPI: 1659200632
Provider Name (Legal Business Name): MARIAMS COMPASSIONATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 115TH AVE NE
LAKE STEVENS WA
98258-9547
US

IV. Provider business mailing address

2609 115TH AVE NE
LAKE STEVENS WA
98258-9547
US

V. Phone/Fax

Practice location:
  • Phone: 206-669-4338
  • Fax:
Mailing address:
  • Phone: 206-669-4338
  • Fax:

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: MS. MARIAMA CEESAY
Title or Position: PROVIDER
Credential: LPN
Phone: 206-669-4338