Healthcare Provider Details

I. General information

NPI: 1649402405
Provider Name (Legal Business Name): FULL LIFE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4712 35TH AVE S
SEATTLE WA
98118-1704
US

IV. Provider business mailing address

800 JEFFERSON ST STE 620
SEATTLE WA
98104-2421
US

V. Phone/Fax

Practice location:
  • Phone: 206-467-7033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID RICHART
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 206-467-7033