Healthcare Provider Details

I. General information

NPI: 1093634040
Provider Name (Legal Business Name): LIVELY CARE AFH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16412 NE 78TH WAY
VANCOUVER WA
98682-1512
US

IV. Provider business mailing address

16412 NE 78TH WAY
VANCOUVER WA
98682-1512
US

V. Phone/Fax

Practice location:
  • Phone: 503-739-4134
  • Fax:
Mailing address:
  • Phone: 503-739-4134
  • 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: MUQTAR IBRAHIM MOHAMED
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 503-739-4134