=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235610023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARE AND CARE HOUSE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2018
-----------------------------------------------------
Last Update Date | 08/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 702 23RD AVE SE
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-4661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-840-3402
-----------------------------------------------------
Fax | 253-840-3401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 800
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98371-0072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-840-3402
-----------------------------------------------------
Fax | 253-840-3401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | CHARLENE D HAMBLEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-840-3402
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------