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General NPI Number Information
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NPI Number | 1114316494
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Entity Type | Organization
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Legal Business Name | WASHINGTON CARE AFH
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 16603 190TH AVE SE
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City | RENTON
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State | WA
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Zip | 98058-0814
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Country | US
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Telephone | 425-282-4127
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Fax | 206-801-7470
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Provider Business Mailing Address
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Address Line | 147 NW 183RD ST
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City | SHORELINE
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State | WA
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Zip | 98177-3439
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Country | US
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Telephone | 206-801-7174
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Fax | 206-801-7470
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | ROLANDO TANTOCO
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Credential | LPN
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Telephone | 206-801-7174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | 750929
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License Number State | WA
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