Healthcare Provider Details

I. General information

NPI: 1912520123
Provider Name (Legal Business Name): SOUTH KING HEALTHCARE SERVICES,SPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BROADWAY STE 434
TACOMA WA
98402-4445
US

IV. Provider business mailing address

2505 S 320TH ST STE 235
FEDERAL WAY WA
98003-5461
US

V. Phone/Fax

Practice location:
  • Phone: 253-517-8372
  • Fax: 253-737-5772
Mailing address:
  • Phone: 253-517-8372
  • Fax: 253-737-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL N GATHONI
Title or Position: MEDICAL CASE MANAGER
Credential:
Phone: 253-517-8372