NPIMap

Organization Active NPI

Mirabella

Doing business as Mirabella Seattle

  • Skilled Nursing Facility
  • Seattle, WA
National Provider Identifier
1679722805
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MIRABELLA
Doing business as
Mirabella Seattle
Practice address
116 Fairview Ave N
Seattle, WA 98109-5360
Phone
(206) 254-1400
NPI assigned
Sep 11, 2008
Last updated
Aug 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2026

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

Authorized official

Name
Alice Bouman
Title
Executive Director
Phone
(206) 254-1414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

116 Fairview Ave N
Seattle, WA 98109-5360

Mailing address

116 Fairview Ave N
Seattle, WA 98109-5360

Other identifiers 1

IdentifierTypeStateIssuer
1501OtherWANURSING HOME LICENSE

Other names 1

  • Mirabella Seattle Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141009001349 WA Part A Provider - Skilled Nursing Facility 2769543214 Practice locations: Seattle, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679722805. Details of each certification follow.

Skilled nursing facility certification: CCN 505520

Legal name
MIRABELLA
Doing business as
MIRABELLA SEATTLE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 28, 2009
Last certification
Jun 28, 2024
Beds
46
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Pacific Retirement Services
Organization structure
CorporationNon-profit
Incorporated
Jan 5, 2005 in WA
Enrollment address
116 Fairview Ave N
Seattle, WA 98109-5360
Nursing home name
MIRABELLA

Care Compare: Nursing home

Medicare Care Compare
Listed as
MirabellaCCN 505520 · All quality measures
Overall star rating
5 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 28, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4637.6 residents per day on average
Penalties (3 years)
3Fines totaling $23,463

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D1090699Mirabella116 Fairview Ave, Seattle, WA 98109Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Janet Kiernan Individual Operational/Managerial Control Jul 16, 2023
Adp of the SNF Jul 16, 2023
Alex Candalla Individual Corporate OfficerInterim Executive Director Jan 21, 2026
Operational/Managerial Control Jan 21, 2026
Adp of the SNF Jan 21, 2026
Anthony Sabatini Individual Operational/Managerial Control Dec 20, 2024
Adp of the SNF Dec 20, 2024
Elise Fuller Individual Operational/Managerial Control Jun 17, 2025
Adp of the SNF Jun 17, 2025
Oleg Zaslavsky Individual Corporate OfficerVice Chair Jan 1, 2024
Corporate DirectorVice Chair Oct 1, 2024
Aaron T Fang Individual Operational/Managerial Control Nov 1, 2025
Adp of the SNF Nov 1, 2025
Lee D Burnside Individual Corporate OfficerBoard Chair Oct 1, 2024
Corporate DirectorBoard Chair Oct 1, 2024
Pacific Retirement Services Inc Organization, Medford, OR Corporation, Non-profit, Chain home office Operational/Managerial Control Mar 4, 2005
Adp of the SNF Mar 4, 2005

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786924800000",
    "number": "1679722805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 FAIRVIEW AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981095360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 FAIRVIEW AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981095360",
            "telephone_number": "206-254-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRABELLA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-11",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A",
        "authorized_official_last_name": "BOUMAN",
        "authorized_official_first_name": "ALICE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "206-254-1414"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING HOME LICENSE",
            "identifier": "1501",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mirabella Seattle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.