Star Lake Adult Family Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

750042 Issued in WA

Legal business name

STAR LAKE ADULT FAMILY HOME

Practice address

3509 S 272ND St
Kent, WA 98032-7062

Phone

(253) 859-3220

Fax

(253) 854-0494

NPI assigned

Mar 11, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Vasilica David, NARNPI 1366868077

Title

Owner/Provider

Phone

(253) 859-3220

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vasilica David

  • Adult Care Home Facility
  • Kent, WA
  • NPI 1366868077
  NPD (past) Authorized official

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

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1932379534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3509 S 272ND ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980327062",
            "telephone_number": "253-859-3220",
            "fax_number": "253-854-0494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 S 272ND ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980327062",
            "telephone_number": "253-859-3220",
            "fax_number": "253-854-0494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR LAKE ADULT FAMILY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "DAVID",
        "authorized_official_first_name": "VASILICA",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "253-859-3220",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NAR"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "WA",
            "license": "750042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Kent, WA
• Providers in Kent, WA by specialty
• Adult Care Home Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.