EVERGREEN PARK AFH
NPI 1912794819
Custodial Care Facility - Adult Care Home in Bellevue, WA
- Organization
- Custodial Care Facility
- Adult Care Home
- CLIA Number: 50D2292949
- CLIA Cert. Type: Other - AFH
- CLIA Exp. Date: 04-04-2028
About EVERGREEN PARK AFH
This page provides the complete NPI Profile along with additional information for Evergreen Park Afh, a provider established in Bellevue, Washington operating as a Custodial Care Facility, focusing in adult care home . The healthcare provider is registered in the NPI registry with number 1912794819 assigned on April 2025. The practitioner's primary taxonomy code is 311ZA0620X. The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Adrian Balasa (Office Administrator)
- NPI
- 1912794819 Verify this NPI
- Provider Name
- EVERGREEN PARK AFH
- Entity Type
- Organization
- Location Address
- 17126 SE 29TH PL BELLEVUE, WA 98008
- Location Phone
- (206) 660-1273
- Mailing Address
- 17126 SE 29TH PL BELLEVUE, WA 98008
- Mailing Phone
- (206) 660-1273
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-23-2025
- Last Update Date
- 04-23-2025
- Code Navigator
Location Map
Secondary Locations
- 142 S 295th Pl
Federal Way, WA 98003
(253) 839-9438 - 7520 E Green Lake Dr N
Seattle, WA 98103
(206) 985-2048 - 32020 11th Ave SW
Federal Way, WA 98023
(253) 344-1139
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Custodial Care Facility Adult Care Home
- Taxonomy Code
- 311ZA0620X
- Type
- Nursing & Custodial Care Facilities
- Taxonomy Description
- A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 50D2292949
- Facility Type
- Other - AFH
- Certificate Effective Date
- November 01, 2023
- Certificate Expiration Date
- April 04, 2028
- Laboratory Director
- SAYH SAIDA
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Evergreen Park Afh to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1912794819, enumerated as an "organization" on April 23, 2025.
The provider is located at 17126 SE 29TH PL BELLEVUE, WA 98008 and the phone number is (206) 660-1273.
Custodial Care Facility with taxonomy code 311ZA0620X and a focus in Adult Care Home.
