MEDICARE: LAHAI HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1235683194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAHAI HEALTH

Provider Business Mailing Address
First Line	:	19820 SCRIBER LAKE RD STE 2
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-6121
Country	:	US
Telephone Number	:	206-363-4105
Fax Number	:	206-823-1010

Provider Business Practice Location Address
First Line	:	19820 SCRIBER LAKE RD STE 2
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-6121
Country	:	US
Telephone Number	:	206-363-4105
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	LARRY RAFFERTY
Credential	:
Telephone Number	:	206-363-4105

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/01/2024

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