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General NPI Number Information
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NPI Number | 1477720589
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Entity Type | Organization
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Legal Business Name | ANSARA FAMILY HOME LLC
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 424 174TH PL NE
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City | BELLEVUE
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State | WA
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Zip | 98008-4245
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Country | US
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Telephone | 425-562-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 8225 59TH ST NW
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City | GIG HARBOR
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State | WA
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Zip | 98335-6261
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Country | US
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Telephone | 253-857-6566
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. CHERYL A ANSARA
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Credential |
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Telephone | 253-857-6566
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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 | 750183
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License Number State | WA
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