Provider Demographics
NPI:1821785833
Name:ANGEL STARS AFH LLC
Entity Type:Organization
Organization Name:ANGEL STARS AFH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIIRU
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:206-954-6431
Mailing Address - Street 1:484 S 190TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2044
Mailing Address - Country:US
Mailing Address - Phone:206-954-6431
Mailing Address - Fax:800-573-7095
Practice Address - Street 1:484 S 190TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-2044
Practice Address - Country:US
Practice Address - Phone:206-954-6431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home