Healthcare Provider Details

I. General information

NPI: 1629713623
Provider Name (Legal Business Name): DENALI CARE SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31620 23RD AVE S # 302
FEDERAL WAY WA
98003-5064
US

IV. Provider business mailing address

31620 23RD AVE S # 302
FEDERAL WAY WA
98003-5064
US

V. Phone/Fax

Practice location:
  • Phone: 206-592-2756
  • Fax: 206-238-9450
Mailing address:
  • Phone: 206-592-2756
  • Fax: 206-238-9450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ENI IERUSALEMA MAVAEGA
Title or Position: CO-OWNER
Credential:
Phone: 907-297-8942