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General NPI Number Information
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NPI Number | 1821817594
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Entity Type | Organization
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Legal Business Name | DEPOT STREET PROPERTIES INC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 12217 SE MCGILLIVRAY BLVD
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City | VANCOUVER
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State | WA
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Zip | 98683-6343
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Country | US
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Telephone | 360-314-4858
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Fax | 360-433-9031
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Provider Business Mailing Address
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Address Line | 14 N DEPOT ST
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City | RIDGEFIELD
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State | WA
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Zip | 98642-9325
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Country | US
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Telephone | 360-823-3140
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Fax | 360-433-9031
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | LESLIE SWINDELL
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Credential |
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Telephone | 360-823-3140
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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 |
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License Number State |
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