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General NPI Number Information
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NPI Number | 1952527160
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Entity Type | Organization
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Legal Business Name | NORMANDY PARK ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16625 1ST AVE S
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City | BURIEN
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State | WA
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Zip | 98148-1427
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Country | US
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Telephone | 206-241-0821
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Fax | 206-241-0708
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Provider Business Mailing Address
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Address Line | 4610 NE 77TH AVE SUITE 132
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City | VANCOUVER
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State | WA
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Zip | 98662-6789
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Country | US
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Telephone | 206-241-0821
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Fax | 206-241-0708
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DONNA LAVERLY
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Credential |
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Telephone | 206-241-0821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | BH1688
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License Number State | WA
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