Healthcare Provider Details

I. General information

NPI: 1386883866
Provider Name (Legal Business Name): CORMEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 75TH PL SE # 101
MERCER ISLAND WA
98040-2778
US

IV. Provider business mailing address

2811 75TH PL SE # 101
MERCER ISLAND WA
98040
US

V. Phone/Fax

Practice location:
  • Phone: 206-941-0945
  • Fax:
Mailing address:
  • Phone: 206-941-0945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROLAND CLARKE
Title or Position: CEO
Credential:
Phone: 206-353-1230