Healthcare Provider Details

I. General information

NPI: 1285954628
Provider Name (Legal Business Name): PRAESTO COMMUNITY FUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 CARILLON PT
KIRKLAND WA
98033-7357
US

IV. Provider business mailing address

5400 CARILLON PT
KIRKLAND WA
98033-7357
US

V. Phone/Fax

Practice location:
  • Phone: 480-559-1004
  • Fax: 866-451-6888
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number603011989
License Number StateWA

VIII. Authorized Official

Name: ANDREW W. MORRISON
Title or Position: PRESIDENT / FOUNDER
Credential:
Phone: 480-559-1004