Healthcare Provider Details

I. General information

NPI: 1275470544
Provider Name (Legal Business Name): 144 FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 SE PETROVITSKY RD APT G202
RENTON WA
98055-5691
US

IV. Provider business mailing address

11100 SE PETROVITSKY RD APT G202
RENTON WA
98055-5691
US

V. Phone/Fax

Practice location:
  • Phone: 972-904-2691
  • Fax:
Mailing address:
  • Phone: 972-904-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: EVANS KAKOMA
Title or Position: MD
Credential:
Phone: 972-904-2691