Provider Demographics
NPI:1427743343
Name:NEWCASTLE ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:NEWCASTLE ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BERHANU
Authorized Official - Middle Name:ALEMU
Authorized Official - Last Name:GURUMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-412-0578
Mailing Address - Street 1:6583 125TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3936
Mailing Address - Country:US
Mailing Address - Phone:206-412-0578
Mailing Address - Fax:
Practice Address - Street 1:6583 125TH AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-3936
Practice Address - Country:US
Practice Address - Phone:206-412-0578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home