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1811383342 NPI number — FORT VANCOUVER MEMORY CARE, LLC

NPI Number: 1811383342
Health Care Provider/Practitioner: FORT VANCOUVER MEMORY CARE, LLC

Information about “1811383342” NPI (FORT VANCOUVER MEMORY CARE, LLC) exists in 1811383342 in HTML format HTML  |  1811383342 in plain Text format TXT  |  1811383342 in PDF (Portable Document Format) PDF  |  1811383342 in an XML format XML  formats.

NPI Number : 1811383342 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811383342",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "EMPRES WASHINGTON HEALTHCARE, LLC",
    "ParentOrgTIN": null,
    "OrgName": "FORT VANCOUVER MEMORY CARE, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4601 NE 77TH AVE",
    "SecondLineMailingAddress": "SUITE 300",
    "MailingAddressCityName": "VANCOUVER",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98662-6729",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-892-6628",
    "MailingAddressFaxNumber": "360-882-5793",
    "FirstLinePracticeLocationAddress": "8507 NE 8TH WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VANCOUVER",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98664-1980",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-892-6628",
    "PracticeLocationAddressFaxNumber": "360-882-5793",
    "EnumerationDate": "04/10/2015",
    "LastUpdateDate": "04/10/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PATTERSON",
    "AuthorizedOfficialFirstName": "DALE",
    "AuthorizedOfficialMiddleName": "L.",
    "AuthorizedOfficialTitle": "CEO AND MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "360-892-6628",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "311500000X",
        "TaxonomyName": "Alzheimer Center (Dementia Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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