=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730920539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATER HEIGHTS AFH CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2024
-----------------------------------------------------
Last Update Date | 06/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10027 SE 245TH PL
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98030-5129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-734-4540
-----------------------------------------------------
Fax | 206-701-0874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10027 SE 245TH PL
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98030-5129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-734-4540
-----------------------------------------------------
Fax | 206-701-0874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MATHEW KIRORI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-734-4540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------