Provider Demographics
NPI:1851155907
Name:ELDER VILLAGE RENTON HIGHLANDS AFH, LLC
Entity Type:Organization
Organization Name:ELDER VILLAGE RENTON HIGHLANDS AFH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUIFUA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:206-886-1611
Mailing Address - Street 1:603 NILE AVE NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4980
Mailing Address - Country:US
Mailing Address - Phone:206-886-1611
Mailing Address - Fax:
Practice Address - Street 1:603 NILE AVE NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4980
Practice Address - Country:US
Practice Address - Phone:206-886-1611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1477166031Medicaid