Healthcare Provider Details

I. General information

NPI: 1467574855
Provider Name (Legal Business Name): ADULTCARE OF RENTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 E VALLEY RD STE 101
RENTON WA
98055-4954
US

IV. Provider business mailing address

3900 E VALLEY RD STE 101
RENTON WA
98055-4954
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-0205
  • Fax:
Mailing address:
  • Phone: 425-251-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number602164615
License Number StateWA

VIII. Authorized Official

Name: CYNTHIA B JENSEN
Title or Position: CLINICAL DIRECTOR
Credential: ARNP
Phone: 425-251-0205