Healthcare Provider Details

I. General information

NPI: 1679310957
Provider Name (Legal Business Name): VAN-INN II, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAIN ST
VANCOUVER WA
98660-3188
US

IV. Provider business mailing address

500 MAIN ST
VANCOUVER WA
98660-3188
US

V. Phone/Fax

Practice location:
  • Phone: 360-696-4000
  • Fax: 360-906-1537
Mailing address:
  • Phone: 360-696-4000
  • Fax: 360-906-1537

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

VIII. Authorized Official

Name: TABATHA ANDREWS
Title or Position: ACCOUNTING
Credential:
Phone: 360-696-4000