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General NPI Number Information
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NPI Number | 1720562119
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Entity Type | Organization
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Legal Business Name | CHRIST THE KING COMMUNITY OUTREACH
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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 | 8609 PORTLAND AVE E
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City | TACOMA
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State | WA
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Zip | 98445-4187
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Country | US
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Telephone | 253-278-0212
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Fax | 253-531-4228
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Provider Business Mailing Address
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Address Line | 8609 PORTLAND AVE E
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City | TACOMA
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State | WA
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Zip | 98445-4187
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Country | US
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Telephone | 253-278-0212
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Fax | 253-531-4228
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MR. DWIGHT BRISKE
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Credential |
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Telephone | 253-278-0212
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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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