Provider Demographics
NPI:1043923121
Name:ADELLA ELDERCARE GROUP LLC
Entity Type:Organization
Organization Name:ADELLA ELDERCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADELLA
Authorized Official - Middle Name:MUMBUA
Authorized Official - Last Name:MWANZIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-502-7084
Mailing Address - Street 1:2904 S 288TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7908
Mailing Address - Country:US
Mailing Address - Phone:206-502-7084
Mailing Address - Fax:
Practice Address - Street 1:2904 S 288TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7908
Practice Address - Country:US
Practice Address - Phone:206-502-7084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care