Provider Demographics
NPI:1528785581
Name:GOLDEN PARK LANE AFH, LLC
Entity type:Organization
Organization Name:GOLDEN PARK LANE AFH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MUGURE
Authorized Official - Last Name:KAMAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-221-6964
Mailing Address - Street 1:34628 14TH PL SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-7038
Mailing Address - Country:US
Mailing Address - Phone:763-221-6964
Mailing Address - Fax:253-344-1464
Practice Address - Street 1:34628 14TH PL SW
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-7038
Practice Address - Country:US
Practice Address - Phone:763-221-6964
Practice Address - Fax:253-344-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA311ZA0620XMedicaid