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General NPI Number Information
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NPI Number | 1396130167
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Entity Type | Organization
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Legal Business Name | CROWN ASSISTED LIVING DEVELOPMENT
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 1609 S UNION AVE
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City | TACOMA
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State | WA
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Zip | 98405-1937
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Country | US
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Telephone | 253-779-3800
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Fax | 253-779-3822
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Provider Business Mailing Address
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Address Line | 1609 S UNION AVE
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City | TACOMA
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State | WA
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Zip | 98405-1937
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Country | US
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Telephone | 253-779-3800
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Fax | 253-779-3822
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. PATRICIA A WALKER
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Credential | RN,BSN,MA
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Telephone | 253-779-3800
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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 | 601457699
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License Number State | WA
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