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General NPI Number Information
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NPI Number | 1083128375
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Entity Type | Organization
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Legal Business Name | VERDANT GROVE ADULT FAMILY HOME, LLC
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 9644 54TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98118-5705
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Country | US
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Telephone | 206-722-2766
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Fax |
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Provider Business Mailing Address
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Address Line | 9650 54TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98118-5705
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | LILIA PEROS SADUCOS
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Credential |
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Telephone | 206-694-3513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 751083
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License Number State | WA
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