Healthcare Provider Details

I. General information

NPI: 1063380269
Provider Name (Legal Business Name): EMERALD CITY IBHTF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8217 S HOSMER ST
TACOMA WA
98408-1044
US

IV. Provider business mailing address

11585 BARKLEY LN
GIG HARBOR WA
98332-9529
US

V. Phone/Fax

Practice location:
  • Phone: 253-240-8950
  • Fax:
Mailing address:
  • Phone: 253-240-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CARA BOWYER
Title or Position: OWNER/OPERATOR
Credential: MLS, BSN, RN
Phone: 253-240-8950