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General NPI Number Information
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NPI Number | 1124455803
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Entity Type | Organization
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Legal Business Name | TANYA'S ADULT FAMILY HOMES LLC
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 16505 N PARK AVE N
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City | SHORELINE
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State | WA
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Zip | 98133-5322
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Country | US
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Telephone | 206-542-6196
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Fax |
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Provider Business Mailing Address
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Address Line | 16505 N PARK AVE N
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City | SHORELINE
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State | WA
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Zip | 98133-5322
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Country | US
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Telephone | 206-542-6196
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | TATYANA VOLODYN
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Credential | CNA
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Telephone | 206-542-6196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 751608
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 751609
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License Number State | WA
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