Healthcare Provider Details

I. General information

NPI: 1114247442
Provider Name (Legal Business Name): NEWBORN TRANSITIONAL CARE NURSERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16006 ASH WAY SUITE 103
LYNNWOOD WA
98087-6352
US

IV. Provider business mailing address

PO BOX 5066
EVERETT WA
98206-5066
US

V. Phone/Fax

Practice location:
  • Phone: 425-422-6557
  • Fax:
Mailing address:
  • Phone: 425-422-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number603012269
License Number StateWA

VIII. Authorized Official

Name: MS. WENDY WHITE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 425-422-6557