Healthcare Provider Details

I. General information

NPI: 1629980909
Provider Name (Legal Business Name): THE FUN SIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 164TH AVE NE STE 222
REDMOND WA
98052-7615
US

IV. Provider business mailing address

8201 164TH AVE NE STE 222
REDMOND WA
98052-7615
US

V. Phone/Fax

Practice location:
  • Phone: 425-947-2265
  • Fax: 800-646-7710
Mailing address:
  • Phone: 425-947-2265
  • Fax: 800-646-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN SKODA
Title or Position: OWNER
Credential:
Phone: 425-947-2265