Healthcare Provider Details

I. General information

NPI: 1720933518
Provider Name (Legal Business Name): 4TH LINE SERVICES INCORPROATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25858 240TH PL SE
MAPLE VALLEY WA
98038-8211
US

IV. Provider business mailing address

25858 240TH PL SE
MAPLE VALLEY WA
98038-8211
US

V. Phone/Fax

Practice location:
  • Phone: 206-557-2926
  • Fax:
Mailing address:
  • Phone: 206-557-2926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PETER JULIEN ORTIZ
Title or Position: PRESIDENT
Credential:
Phone: 206-557-2926