Healthcare Provider Details

I. General information

NPI: 1649411190
Provider Name (Legal Business Name): PREMIER NURSING CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5707 SOUTH AUGUSTA ST
SEATTLE WA
98178
US

IV. Provider business mailing address

5707 SOUTH AUGUSTA ST
SEATTLE WA
98178
US

V. Phone/Fax

Practice location:
  • Phone: 206-722-5100
  • Fax: 206-722-0394
Mailing address:
  • Phone: 206-722-5100
  • Fax: 206-722-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00162766
License Number StateWA

VIII. Authorized Official

Name: FORSON ADDAE BOATENG
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 206-722-5100