Healthcare Provider Details

I. General information

NPI: 1417819343
Provider Name (Legal Business Name): NEW ERA ADULT FAMILY HOME AT LYNNWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 188TH ST SW
LYNNWOOD WA
98037-7248
US

IV. Provider business mailing address

428 218TH ST SW
BOTHELL WA
98021-8155
US

V. Phone/Fax

Practice location:
  • Phone: 206-355-2562
  • Fax: 425-382-7643
Mailing address:
  • Phone: 206-355-2562
  • Fax: 425-382-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MESFIN GEWE
Title or Position: PROVIDER
Credential:
Phone: 206-355-2562