Healthcare Provider Details

I. General information

NPI: 1114721727
Provider Name (Legal Business Name): MILLCREEK AFH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12024 GREENWOOD AVE N
SEATTLE WA
98133-8130
US

IV. Provider business mailing address

16000 75TH PL W
EDMONDS WA
98026-4524
US

V. Phone/Fax

Practice location:
  • Phone: 425-750-5803
  • Fax:
Mailing address:
  • Phone: 425-750-5803
  • 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: JORGE A FLOREZ
Title or Position: OWNER/PROVIDER
Credential:
Phone: 425-750-5803