Healthcare Provider Details

I. General information

NPI: 1518581933
Provider Name (Legal Business Name): LONGHOUSE NORTHGATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11339 8TH AVE NE
SEATTLE WA
98125-6110
US

IV. Provider business mailing address

11339 8TH AVE NE
SEATTLE WA
98125-6110
US

V. Phone/Fax

Practice location:
  • Phone: 206-366-1771
  • Fax: 206-365-0827
Mailing address:
  • Phone: 206-366-1771
  • Fax: 206-365-0827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW LONG
Title or Position: OWNER AND DIRECTOR
Credential:
Phone: 206-307-4775