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General NPI Number Information
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NPI Number | 1861641821
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Entity Type | Organization
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Legal Business Name | SHIRLEY'S INCORPORATED
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 27121 174TH PL SE
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City | COVINGTON
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State | WA
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Zip | 98042-4939
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Country | US
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Telephone | 253-639-8750
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Fax |
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Provider Business Mailing Address
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Address Line | 14236 SE 202ND ST
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City | KENT
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State | WA
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Zip | 98042-3040
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Country | US
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Telephone | 206-919-0662
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MISS DENA COHEN
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Credential | LMP
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Telephone | 206-919-0662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MA00019252
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License Number State | WA
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