Provider Demographics
NPI:1356224836
Name:PURE ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:PURE ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ESAYAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEZGEBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-931-3163
Mailing Address - Street 1:4220 S 246TH CT
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4155
Mailing Address - Country:US
Mailing Address - Phone:206-931-3163
Mailing Address - Fax:253-392-2427
Practice Address - Street 1:2912 SW 333RD ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2727
Practice Address - Country:US
Practice Address - Phone:253-293-6245
Practice Address - Fax:253-392-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home