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General NPI Number Information
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NPI Number | 1467892117
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Entity Type | Organization
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Legal Business Name | GOLDEN COTTAGE AFH. INC.
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 13809 125TH AVE NE
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City | KIRKLAND
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State | WA
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Zip | 98034-2259
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Country | US
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Telephone | 425-821-9170
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Fax | 425-821-0830
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Provider Business Mailing Address
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Address Line | 13809 125TH AVE NE
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City | KIRKLAND
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State | WA
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Zip | 98034-2259
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Country | US
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Telephone | 425-821-9170
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Fax | 425-821-0830
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA STELA CIORBA
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Credential |
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Telephone | 425-821-9170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 611500
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License Number State | WA
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