Healthcare Provider Details

I. General information

NPI: 1558272419
Provider Name (Legal Business Name): GLADNESS & ILYA ADULT FAMILY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 SE 30TH PL
RENTON WA
98055-5201
US

IV. Provider business mailing address

1724 SE 30TH PL
RENTON WA
98055-5201
US

V. Phone/Fax

Practice location:
  • Phone: 425-757-7425
  • Fax:
Mailing address:
  • Phone: 425-757-7425
  • Fax: 425-572-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ILYA GLADKOV
Title or Position: PROVIDER/ OWNER
Credential:
Phone: 425-757-7425