Healthcare Provider Details

I. General information

NPI: 1285841205
Provider Name (Legal Business Name): ESC - SILVERDALE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NW TOWER VIEW CIR
SILVERDALE WA
98383-8674
US

IV. Provider business mailing address

3131 ELLIOTT AVE STE 500
SEATTLE WA
98121-1032
US

V. Phone/Fax

Practice location:
  • Phone: 360-697-4488
  • Fax: 360-697-4771
Mailing address:
  • Phone: 206-298-2909
  • Fax: 206-301-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberBH1669
License Number StateWA

VIII. Authorized Official

Name: NOELLE DIAZ
Title or Position: LICENSING SPECIALIST
Credential:
Phone: 206-301-4060