A Tulelake Afh LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

A TULELAKE AFH LLC

Practice address

13211 Tule Lake Ave S
Parkland, WA 98444-2105

Phone

(253) 533-3031

NPI assigned

Oct 12, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ngonyo Mwangi

Title

Business Operations Manager

Phone

(253) 533-3031

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tulelake avenue comfort home llc Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633996800000",
    "number": "1013679505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13211 TULE LAKE AVE S",
            "city": "PARKLAND",
            "state": "WA",
            "postal_code": "984442105",
            "telephone_number": "253-533-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13211 TULE LAKE AVE S",
            "city": "PARKLAND",
            "state": "WA",
            "postal_code": "984442105",
            "telephone_number": "253-533-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A TULELAKE AFH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-12",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A",
        "authorized_official_last_name": "MWANGI",
        "authorized_official_first_name": "NGONYO",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS MANAGER",
        "authorized_official_telephone_number": "253-533-3031"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2170003",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tulelake avenue comfort home llc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Lisa Lanette Allen
• Cheryl Ancog, ARNP
• Bonnie Baker, CDP
• Karen Crossman, MS SLP
• Tracy Jane Dodgen I

• In Home Supportive Care Agency in Parkland, WA
• Providers in Parkland, WA by specialty
• In Home Supportive Care Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.