Healthcare Provider Details

I. General information

NPI: 1538330832
Provider Name (Legal Business Name): VALLEY VIEW SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SUMMIT AVE N
KENT WA
98030-4707
US

IV. Provider business mailing address

615 SUMMIT AVE N
KENT WA
98030-4707
US

V. Phone/Fax

Practice location:
  • Phone: 263-850-8439
  • Fax: 253-373-1399
Mailing address:
  • Phone: 263-850-8439
  • Fax: 253-373-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number695200
License Number StateWA

VIII. Authorized Official

Name: MRS. JENNIFER MAY POTRA
Title or Position: PROVIDER
Credential:
Phone: 253-850-8439