Organization
A TULELAKE AFH LLC
Active
Other names
Tulelake avenue comfort home llc
Organization subpart
No
Provider details
NPI number
Authorized official
NGONYO MWANGI (BUSINESS OPERATIONS MANAGER)
(253) 533-3031
Entity
Organization
Contact information
Practice address
13211 TULE LAKE AVE S, PARKLAND, WA 98444-2105
(253) 533-3031
Mailing address
13211 TULE LAKE AVE S, PARKLAND, WA 98444-2105
(253) 533-3031
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2170003
—
WA
Enumeration date
10/12/2021
Last updated
10/12/2021
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