Healthcare Provider Details

I. General information

NPI: 1689363079
Provider Name (Legal Business Name): PEOPLES SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E 67TH ST
TACOMA WA
98404-4223
US

IV. Provider business mailing address

11939 NW PIONEER RD
SEABECK WA
98380-9008
US

V. Phone/Fax

Practice location:
  • Phone: 253-474-1741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: JANELLE RYAN
Title or Position: DIRECTOR OF ACCOUNTING SERVICES
Credential:
Phone: 253-222-0658