Provider Demographics
NPI:1124803481
Name:A MAJE MANOR ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:A MAJE MANOR ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOCTOT
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:425-586-0255
Mailing Address - Street 1:12912 SE 186TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7981
Mailing Address - Country:US
Mailing Address - Phone:425-586-0255
Mailing Address - Fax:
Practice Address - Street 1:16608 NE 19TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2686
Practice Address - Country:US
Practice Address - Phone:425-586-0255
Practice Address - Fax:425-746-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care