Provider Demographics
NPI:1235971581
Name:97TH AVENUE ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:97TH AVENUE ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-238-7203
Mailing Address - Street 1:7303 97TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:253-317-2981
Practice Address - Street 1:7303 97TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-3324
Practice Address - Country:US
Practice Address - Phone:253-238-7203
Practice Address - Fax:253-317-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home