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General NPI Number Information
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NPI Number | 1861701187
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Entity Type | Organization
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Legal Business Name | PRODIGALS INTERNATIONAL
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 17320 135TH AVE NE SUITE C
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City | WOODINVILLE
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State | WA
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Zip | 98072-8565
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Country | US
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Telephone | 425-419-6016
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Fax |
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Provider Business Mailing Address
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Address Line | 6619 132ND AVE NE PMB 262
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City | KIRKLAND
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State | WA
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Zip | 98033-8627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN DULANEY
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Credential |
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Telephone | 425-419-6016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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