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General NPI Number Information
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NPI Number | 1427856897
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Entity Type | Organization
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Legal Business Name | 4 ELEMENTS AFH, LLC
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 9111 9TH AVE SE
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City | EVERETT
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State | WA
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Zip | 98208-3316
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Country | US
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Telephone | 206-778-9199
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Fax |
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Provider Business Mailing Address
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Address Line | 218 MAIN ST # 308
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City | KIRKLAND
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State | WA
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Zip | 98033-6108
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Country | US
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Telephone | 206-779-9199
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Fax | 425-265-9549
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | IAN WALLACE
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Credential | NURSE AID
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Telephone | 206-778-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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