Healthcare Provider Details

I. General information

NPI: 1649497603
Provider Name (Legal Business Name): POPE'S KIDS PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 WASHINGTON WAY
CENTRALIA WA
98531-9325
US

IV. Provider business mailing address

230 WASHINGTON WAY
CENTRALIA WA
98531-9325
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-9178
  • Fax: 360-736-8312
Mailing address:
  • Phone: 360-736-9178
  • Fax: 360-736-8312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANK MILLWOOD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 360-736-9178