=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235855578
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENCARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2022
-----------------------------------------------------
Last Update Date | 10/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310200 23RD AVE S
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-941-5859
-----------------------------------------------------
Fax | 253-941-3470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310200 23RD AVE S
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-941-5859
-----------------------------------------------------
Fax | 253-941-3470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | DANIELLE PARKER
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 206-467-2620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------