| NPI | 1356795652 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | WILLIAM LEE WHITEMAN Caregiver 206-775-0985 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA nar.na.00175848) |
| Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: WA nar.na.00175848) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2016-04-22 |