Healthcare Provider Details

I. General information

NPI: 1790914109
Provider Name (Legal Business Name): POPE'S KIDS PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
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 TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberIHS.FS.60083889
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA DICKSON
Title or Position: HR
Credential:
Phone: 360-736-9178