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General NPI Number Information
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NPI Number | 1003772534
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Entity Type | Organization
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Legal Business Name | MONTEVERA PEARL RESIDENCE LLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 815 S PEARL ST
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City | TACOMA
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State | WA
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Zip | 98465-2117
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Country | US
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Telephone | 253-881-7680
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Fax |
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Provider Business Mailing Address
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Address Line | 8007 51ST AVE SW
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City | LAKEWOOD
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State | WA
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Zip | 98499-4051
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Country | US
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Telephone | 253-881-7680
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JEAN MONTENEGRO DE VERA
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Credential | RN
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Telephone | 253-881-7680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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