Healthcare Provider Details

I. General information

NPI: 1679510150
Provider Name (Legal Business Name): TACOMA CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 S 96TH ST
TACOMA WA
98444-1753
US

IV. Provider business mailing address

2102 S 96TH ST
TACOMA WA
98444-1753
US

V. Phone/Fax

Practice location:
  • Phone: 253-581-2514
  • Fax: 253-581-2434
Mailing address:
  • Phone: 253-581-2514
  • Fax: 253-581-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1377
License Number StateWA

VIII. Authorized Official

Name: GREGORY J VISLOCKY
Title or Position: EX VP OF FINANCE / PARTNER
Credential:
Phone: 360-735-7155