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General NPI Number Information
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NPI Number | 1972473999
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Entity Type | Organization
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Legal Business Name | PHYLLIS CARES ADULT FAMILY HOME ONE LLC
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 7626 97TH AVE SW
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City | LAKEWOOD
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State | WA
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Zip | 98498-3246
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Country | US
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Telephone | 253-503-7133
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Fax | 253-503-7151
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Provider Business Mailing Address
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Address Line | 7626 97TH AVE SW
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City | LAKEWOOD
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State | WA
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Zip | 98498-3246
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Country | US
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Telephone | 253-503-7133
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Fax | 253-503-7151
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Authorized Official
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Title or Position | PROVIDER
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Name | MR. ELIUD GITHIRI
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Credential | PROVIDER
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Telephone | 253-459-2540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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