Organization
LYDIE ADULT FAMILY HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN SYLVAIN MISESO KABUYA RN (PROVIDER)
(206) 850-9109
Entity
Organization
Contact information
Practice address
11019 50TH AVE E, TACOMA, WA 98446-5303
(206) 850-9109
Mailing address
16816 116TH AVENUE CT E, PUYALLUP, WA 98374-9119
(206) 850-9109
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
—
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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