Provider Demographics
NPI:1558596361
Name:ARCHSTONE ADULT FAMILY HOME, LLC
Entity Type:Organization
Organization Name:ARCHSTONE ADULT FAMILY HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:425-572-6453
Mailing Address - Street 1:18611 114TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-7124
Mailing Address - Country:US
Mailing Address - Phone:425-572-6453
Mailing Address - Fax:425-572-5526
Practice Address - Street 1:18611 114TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-7124
Practice Address - Country:US
Practice Address - Phone:425-572-6453
Practice Address - Fax:425-572-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA-750346315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient