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General NPI Number Information
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NPI Number | 1770910663
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Entity Type | Organization
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Legal Business Name | PINECONE HEIGHTS CORPORATION
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 1171 CAMAS AVE NE
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City | RENTON
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State | WA
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Zip | 98056-2918
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Country | US
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Telephone | 206-940-1020
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Fax | 425-523-3990
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Provider Business Mailing Address
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Address Line | 10541 SE 226TH ST
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City | KENT
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State | WA
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Zip | 98031-2621
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Country | US
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Telephone | 206-940-1020
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Fax | 425-523-3990
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN J HOLLIDAY
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Credential |
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Telephone | 206-940-1020
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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 | 752487
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License Number State | WA
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