Healthcare Provider Details

I. General information

NPI: 1851386122
Provider Name (Legal Business Name): EMERALD CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N AHTANUM AVE
WAPATO WA
98951-1125
US

IV. Provider business mailing address

209 N AHTANUM AVE
WAPATO WA
98951-1125
US

V. Phone/Fax

Practice location:
  • Phone: 509-877-3175
  • Fax: 509-877-6135
Mailing address:
  • Phone: 509-877-3175
  • Fax: 509-877-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1366
License Number StateWA

VIII. Authorized Official

Name: MR. MICHAEL HOON
Title or Position: ADMINISTRATOR
Credential:
Phone: 509-877-3175