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General NPI Number Information
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NPI Number | 1184895906
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Entity Type | Organization
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Legal Business Name | MARY ADULT FAMILY HOME
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 1438 DOGWOOD ST SE
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City | AUBURN
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State | WA
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Zip | 98092-6476
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Country | US
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Telephone | 253-876-7726
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Fax | 253-876-0063
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Provider Business Mailing Address
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Address Line | 1438 DOGWOOD ST SE
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City | AUBURN
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State | WA
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Zip | 98092-6476
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Country | US
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Telephone | 253-876-7726
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Fax | 253-876-0063
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. MARIA DRAGOMIR
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Credential | NAR
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Telephone | 253-876-7726
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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 | 656400
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License Number State | WA
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