=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043582208
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINDSOR GARDENS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2012
-----------------------------------------------------
Last Update Date | 02/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1602 NE 162ND AVE
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98684-9426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-521-1300
-----------------------------------------------------
Fax | 360-260-3863
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1602 NE 162ND AVE
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98684-9426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-521-1300
-----------------------------------------------------
Fax | 360-260-3863
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. DORI CORINA HATEGAN
-----------------------------------------------------
Credential | ADMINISTRATOR
-----------------------------------------------------
Telephone | 360-521-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | B2117
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------