=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518833490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLOUDLAND HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2025
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17617 111TH AVE SE
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98055-6543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-407-7990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17617 111TH AVE SE
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98055-6543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-407-7990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | MR. ABDIFATAH SALAH
-----------------------------------------------------
Credential | IHS
-----------------------------------------------------
Telephone | 206-407-7990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------