Provider Demographics
NPI:1447008719
Name:ALPHAEDMONDS ADULT FAMILY HOME
Entity type:Organization
Organization Name:ALPHAEDMONDS ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEGBAR
Authorized Official - Middle Name:ADDISU
Authorized Official - Last Name:ASNAKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:425-246-0207
Mailing Address - Street 1:15917 55TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4747
Mailing Address - Country:US
Mailing Address - Phone:425-246-0207
Mailing Address - Fax:
Practice Address - Street 1:15917 55TH PL W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-4747
Practice Address - Country:US
Practice Address - Phone:425-246-0207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home