Provider Demographics
NPI:1831074335
Name:MAZ ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:MAZ ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MVULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-433-1748
Mailing Address - Street 1:4811 LACEY BLVD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5724
Mailing Address - Country:US
Mailing Address - Phone:360-918-8372
Mailing Address - Fax:360-359-7541
Practice Address - Street 1:4811 LACEY BLVD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5724
Practice Address - Country:US
Practice Address - Phone:360-918-8372
Practice Address - Fax:360-359-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home