Provider Demographics
NPI:1457044547
Name:EXCELLENT ADULT FAMILY HOME 2
Entity Type:Organization
Organization Name:EXCELLENT ADULT FAMILY HOME 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMNET
Authorized Official - Middle Name:
Authorized Official - Last Name:TESFAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-751-4476
Mailing Address - Street 1:19114 8TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3000
Mailing Address - Country:US
Mailing Address - Phone:206-629-5986
Mailing Address - Fax:
Practice Address - Street 1:19114 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3000
Practice Address - Country:US
Practice Address - Phone:206-629-5986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care