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General NPI Number Information
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NPI Number | 1447079827
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Entity Type | Organization
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Legal Business Name | EAST TO WEST AGING SERVICES & CONSULTING LLC
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1947 N PRAIRIE LN UNIT 103
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City | LYNDEN
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State | WA
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Zip | 98264-9252
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Country | US
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Telephone | 434-907-0136
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Fax |
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Provider Business Mailing Address
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Address Line | 1947 N PRAIRIE LN UNIT 103
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City | LYNDEN
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State | WA
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Zip | 98264-9252
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Country | US
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Telephone | 564-243-8152
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARA VENCKUS
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Credential |
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Telephone | 540-243-8152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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