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General NPI Number Information
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NPI Number | 1447584594
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Entity Type | Organization
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Legal Business Name | PARK LIDO, INC.
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 8422 NE 8TH WAY
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City | VANCOUVER
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State | WA
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Zip | 98664-1974
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Country | US
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Telephone | 360-256-2980
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Fax | 360-256-1909
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Provider Business Mailing Address
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Address Line | 8422 NE 8TH WAY
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City | VANCOUVER
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State | WA
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Zip | 98664-1974
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Country | US
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Telephone | 360-256-2980
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Fax | 360-256-1909
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RANDALL L. SCHEEL
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Credential |
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Telephone | 360-256-2980
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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 | 2038
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License Number State | WA
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