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General NPI Number Information
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NPI Number | 1528793643
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Entity Type | Organization
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Legal Business Name | MADRONA PEAK LLC
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6430 TACOMA MALL BLVD STE 201
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City | TACOMA
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State | WA
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Zip | 98409-6700
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Country | US
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Telephone | 253-693-4092
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Fax | 253-204-3568
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Provider Business Mailing Address
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Address Line | 6430 TACOMA MALL BLVD STE 201
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City | TACOMA
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State | WA
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Zip | 98409-6700
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Country | US
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Telephone | 253-693-4092
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Fax | 253-204-3568
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Authorized Official
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Title or Position | MEMBER
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Name | JACOB T GAMBLE
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Credential |
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Telephone | 509-251-3016
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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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