Healthcare Provider Details

I. General information

NPI: 1184340184
Provider Name (Legal Business Name): A PLACE TO CALL HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14802 NE 117TH CIR
VANCOUVER WA
98682-1912
US

IV. Provider business mailing address

14802 NE 117TH CIR
VANCOUVER WA
98682-1912
US

V. Phone/Fax

Practice location:
  • Phone: 360-931-1373
  • Fax: 360-882-1633
Mailing address:
  • Phone: 360-931-1373
  • Fax: 360-882-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE JODENE SIMMONS
Title or Position: OWNER ARNP
Credential:
Phone: 360-931-1373