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General NPI Number Information
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NPI Number | 1508685173
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Entity Type | Organization
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Legal Business Name | INFINITE GRACE ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 6113 188TH ST SW
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City | LYNNWOOD
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State | WA
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Zip | 98037-7247
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Country | US
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Telephone | 425-327-2690
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Fax |
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Provider Business Mailing Address
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Address Line | 8120 HARDESON RD UNIT 4158
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City | EVERETT
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State | WA
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Zip | 98204-0109
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Country | US
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Telephone | 425-327-2690
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | JOSEPH GAN
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Credential |
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Telephone | 425-327-2690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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