Healthcare Provider Details

I. General information

NPI: 1902823610
Provider Name (Legal Business Name): SAMARICARE OF LYNNWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19410 36TH AVE W STE 6
LYNNWOOD WA
98036-5747
US

IV. Provider business mailing address

19410 36TH AVE W STE 6
LYNNWOOD WA
98036-5747
US

V. Phone/Fax

Practice location:
  • Phone: 425-771-5306
  • Fax: 425-771-5318
Mailing address:
  • Phone: 425-771-5306
  • Fax: 425-771-5318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number0102276
License Number StateWA

VIII. Authorized Official

Name: DANH NGUYEN
Title or Position: OWNER
Credential:
Phone: 425-771-5306