Healthcare Provider Details

I. General information

NPI: 1003847187
Provider Name (Legal Business Name): LDS FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MONSTER RD SW SUITE 250
RENTON WA
98057-2996
US

IV. Provider business mailing address

1201 MONSTER RD SW SUITE 250
RENTON WA
98057-2996
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-0074
  • Fax: 425-226-2531
Mailing address:
  • Phone: 425-228-0074
  • Fax: 425-226-2531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number600292374
License Number StateWA

VIII. Authorized Official

Name: MR. MARK CASEY
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 425-228-0074