=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831004308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIDGEPORT BLISS AFH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2026
-----------------------------------------------------
Last Update Date | 08/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10414 DOUGLAS DR SW
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98499-4817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-267-1257
-----------------------------------------------------
Fax | 253-867-9644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10414 DOUGLAS DR SW
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98499-4817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-267-1257
-----------------------------------------------------
Fax | 253-867-9644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | JAMES MWANGI KIRAKI
-----------------------------------------------------
Credential | HCA
-----------------------------------------------------
Telephone | 253-590-1922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311Z00000X
-----------------------------------------------------
Taxonomy Name | Custodial Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------