Provider Demographics
NPI:1619837572
Name:BROOK ANGLES ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:BROOK ANGLES ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GITHANDA
Authorized Official - Last Name:MUTHONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-476-0202
Mailing Address - Street 1:19923 137TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7781
Mailing Address - Country:US
Mailing Address - Phone:206-277-9998
Mailing Address - Fax:253-277-9429
Practice Address - Street 1:19923 137TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7781
Practice Address - Country:US
Practice Address - Phone:206-277-9998
Practice Address - Fax:253-277-9429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health