Lily Senior Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

LILY SENIOR HOME

Practice address

3526 168TH PL SW
Lynnwood, WA 98037-3233

Phone

(206) 353-6507

NPI assigned

Aug 30, 2021

Organization subpart

No

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

Authorized official

Name

Elelita Woldemichael

Title

Owner

Phone

(206) 353-6507

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630281600000",
    "number": "1942977640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3526 168TH PL SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980373233",
            "telephone_number": "206-353-6507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3526 168TH PL SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980373233",
            "telephone_number": "206-353-6507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILY SENIOR HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-30",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A",
        "authorized_official_last_name": "WOLDEMICHAEL",
        "authorized_official_first_name": "ELELITA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-353-6507"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Lynnwood",
            "affiliation": "N",
            "endpointDescription": "Washington",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3526 168th Pl SW",
            "city": "Lynnwood",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980373233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.