Provider Demographics
NPI:1407664337
Name:AMAZING SAMAR ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:AMAZING SAMAR ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIWOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CNA, HEALTH CARE MGT
Authorized Official - Phone:425-503-2432
Mailing Address - Street 1:2314 LARLIN DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6932
Mailing Address - Country:US
Mailing Address - Phone:425-503-2432
Mailing Address - Fax:425-405-3622
Practice Address - Street 1:2314 LARLIN DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6932
Practice Address - Country:US
Practice Address - Phone:425-503-2432
Practice Address - Fax:425-405-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home