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General NPI Number Information
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NPI Number | 1689158073
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Entity Type | Organization
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Legal Business Name | FIFTEENTH SENIOR CARE LLC
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 15750 NE 15TH ST
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City | BELLEVUE
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State | WA
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Zip | 98008-2703
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Country | US
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Telephone | 425-641-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 LEGION PL STE 1600
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City | ORLANDO
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State | FL
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Zip | 32801-1060
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Country | US
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Telephone | 407-999-7759
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MR. ROBERT WILLIAM CHAPIN
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Credential |
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Telephone | 407-999-2400
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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 |
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License Number State |
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