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General NPI Number Information
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NPI Number | 1790182053
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Entity Type | Organization
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Legal Business Name | ALASKA GARDENS
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 2549 S MERIDIAN
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City | PUYALLUP
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State | WA
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Zip | 98373-2753
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Country | US
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Telephone | 858-336-4376
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Fax |
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Provider Business Mailing Address
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Address Line | 2549 S MERIDIAN
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City | PUYALLUP
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State | WA
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Zip | 98373-2753
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Country | US
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Telephone | 858-336-4376
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MISS NATRECE NICKISHA BROWN
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Credential | MED
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Telephone | 858-336-4376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | LL60026338
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License Number State | WA
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