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PARADISE LAKE SENIOR CARE HOME, LLC
NPI 1932508868
Custodial Care Facility - Adult Care Home in Snohomish, WA

Active since August 15, 2014CLIA 50D2350573 · Waiver
10121 219TH ST SE, SNOHOMISH, WA 98296(425) 761-7739(360) 668-5297 Get Directions Write a Review

NPPES record last updated: August 15, 2014. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Paradise Lake Senior Care Home, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARADISE LAKE SENIOR CARE HOME, LLC (NPI 1932508868) is a healthcare organization registered as an adult care home in Snohomish, Washington and active in the NPI registry since August 2014. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Theresa Frigillana, Afh Provider, as its authorized official.

NPPES Registry Identity

NPI1932508868
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NamePARADISE LAKE SENIOR CARE HOME, LLC
Location Address10121 219TH ST SESnohomish, WA 98296-4941
Mailing Address10121 219th St SeSnohomish, WA 98296-4941 · (425) 761-7739
Phone(425) 761-7739
Fax(360) 668-5297
Organization SubpartNo
Authorized OfficialTheresa FrigillanaAfh Provider · (425) 761-7739
Enumeration DateAugust 15, 2014
✔ NPI 1932508868 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
License✔ Licensed in WA · 751477
Definition
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.
10121 219TH ST SE, Snohomish, WA 98296
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Other Identifiers 1

Medicaid515305WA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2350573

Paradise Lake Senior Care Center · Snohomish, WA
Active · expires Apr 4, 2028
CLIA Number50D2350573
Laboratory TypeAfh
Certificate Effective DateSeptember 11, 2026
Certificate Expiration DateApril 4, 2028
Laboratory DirectorEtsegenet Simachew
Laboratory Phone(314) 971-5002
Laboratory LocationParadise Lake Senior Care Center10121 219th St SE, Snohomish, WA 98296
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Paradise Lake Senior Care Home, LLC's NPI number?

The NPI number for Paradise Lake Senior Care Home, LLC is 1932508868. It was assigned to this organization in the NPPES registry on August 15, 2014.

Where is Paradise Lake Senior Care Home, LLC located?

Paradise Lake Senior Care Home, LLC is located at 10121 219th St SE, Snohomish, WA 98296. The listed phone number is (425) 761-7739.

What is Paradise Lake Senior Care Home, LLC's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

Does Paradise Lake Senior Care Home, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2350573) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Paradise Lake Senior Care Home, LLC was last updated on August 15, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.