Healthcare Provider Details

I. General information

NPI: 1710897392
Provider Name (Legal Business Name): HIYAB ADULT FAMILY HOME L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18015 ASHWORTH AVE N
SHORELINE WA
98133-4524
US

IV. Provider business mailing address

18015 ASHWORTH AVE N
SHORELINE WA
98133-4524
US

V. Phone/Fax

Practice location:
  • Phone: 206-629-4252
  • Fax: 206-260-7282
Mailing address:
  • Phone: 206-629-4252
  • Fax: 206-260-7282

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: AZEB HADGU
Title or Position: OWNER
Credential:
Phone: 206-629-4252