Healthcare Provider Details

I. General information

NPI: 1114875341
Provider Name (Legal Business Name): STEMUELITA LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12209 A ST S
TACOMA WA
98444-5114
US

IV. Provider business mailing address

12209 A ST S
TACOMA WA
98444-5114
US

V. Phone/Fax

Practice location:
  • Phone: 253-424-2325
  • Fax:
Mailing address:
  • Phone: 253-424-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: OSSAI NELLY OLIME
Title or Position: PROVIDER
Credential: OLIME
Phone: 619-886-4457