Healthcare Provider Details

I. General information

NPI: 1083005367
Provider Name (Legal Business Name): SENIOR SERVICES FOR SOUTH SOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 COLUMBIA ST NW
OLYMPIA WA
98501-8208
US

IV. Provider business mailing address

222 COLUMBIA ST NW
OLYMPIA WA
98501-8208
US

V. Phone/Fax

Practice location:
  • Phone: 360-586-6181
  • Fax: 360-586-7408
Mailing address:
  • Phone: 360-586-6181
  • Fax: 360-586-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberDNA
License Number StateWA

VIII. Authorized Official

Name: EILEEN MCKENZIESULLIVAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 360-586-6181