Provider Demographics
NPI:1215669981
Name:EDMONDS GARDEN AFH LLC
Entity type:Organization
Organization Name:EDMONDS GARDEN AFH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DEREJE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LULU
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:206-549-9648
Mailing Address - Street 1:8621 244TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-9062
Mailing Address - Country:US
Mailing Address - Phone:206-629-4173
Mailing Address - Fax:206-801-7156
Practice Address - Street 1:8621 244TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9062
Practice Address - Country:US
Practice Address - Phone:206-629-4173
Practice Address - Fax:206-801-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care