Healthcare Provider Details

I. General information

NPI: 1427643071
Provider Name (Legal Business Name): ASHLEY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 12/19/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18904 BURKE AVE N
SHORELINE WA
98133-4213
US

IV. Provider business mailing address

33811 9TH AVE S
FEDERAL WAY WA
98003-6707
US

V. Phone/Fax

Practice location:
  • Phone: 253-533-9050
  • Fax:
Mailing address:
  • Phone: 253-533-9050
  • Fax: 253-517-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KEN MAAZ
Title or Position: EXECUTIVE DIRECTOR/CEO
Credential:
Phone: 253-533-9050