Healthcare Provider Details

I. General information

NPI: 1174740112
Provider Name (Legal Business Name): SHILOH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16505 SE 30TH ST UNIT 1
BELLEVUE WA
98008-5625
US

IV. Provider business mailing address

16505 SE 30TH ST
BELLEVUE WA
98008-5625
US

V. Phone/Fax

Practice location:
  • Phone: 425-643-4669
  • Fax: 425-643-8693
Mailing address:
  • Phone: 425-643-4669
  • Fax: 425-643-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number300503
License Number StateWA

VIII. Authorized Official

Name: MR. JEAN BOLDOR
Title or Position: MENAGER
Credential:
Phone: 425-643-4669