Provider Demographics
NPI:1558178962
Name:AUTUMN RIDGE ADULT FAMILY HOME, LLC
Entity type:Organization
Organization Name:AUTUMN RIDGE ADULT FAMILY HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:NGARACHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-753-7090
Mailing Address - Street 1:25337 116TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6537
Mailing Address - Country:US
Mailing Address - Phone:253-277-4469
Mailing Address - Fax:253-888-3545
Practice Address - Street 1:25337 116TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6537
Practice Address - Country:US
Practice Address - Phone:253-277-4469
Practice Address - Fax:253-888-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health