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General NPI Number Information
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NPI Number | 1245862044
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Entity Type | Organization
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Legal Business Name | SENIORWELL OF WASHINGTON LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 1455 NW LEARY WAY STE 400
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City | SEATTLE
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State | WA
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Zip | 98107-5138
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Country | US
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Telephone | 844-882-3127
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 E LAKE COOK RD STE 1000
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1999
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Country | US
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Telephone | 844-882-3127
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN MORONEY
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Credential |
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Telephone | 844-882-3127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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