Healthcare Provider Details

I. General information

NPI: 1891817342
Provider Name (Legal Business Name): ELISEO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N HIGHLANDS PKWY
TACOMA WA
98406-2116
US

IV. Provider business mailing address

1301 N HIGHLANDS PKWY
TACOMA WA
98406-2116
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-7112
  • Fax: 253-752-7265
Mailing address:
  • Phone: 253-752-7112
  • Fax: 253-752-7265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberBH1187
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH601
License Number StateWA

VIII. Authorized Official

Name: MR. DAVID HOFFMAN
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 253-756-7565