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General NPI Number Information
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NPI Number | 1932508868
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Entity Type | Organization
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Legal Business Name | PARADISE LAKE SENIOR CARE HOME, LLC
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 10121 219TH ST SE
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City | SNOHOMISH
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State | WA
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Zip | 98296-4941
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Country | US
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Telephone | 425-761-7739
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Fax | 360-668-5297
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Provider Business Mailing Address
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Address Line | 10121 219TH ST SE
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City | SNOHOMISH
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State | WA
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Zip | 98296-4941
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Country | US
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Telephone | 425-761-7739
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Fax |
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Authorized Official
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Title or Position | AFH PROVIDER
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Name | THERESA FRIGILLANA
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Credential | RN, BSN
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Telephone | 425-761-7739
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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 | 751477
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License Number State | WA
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