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General NPI Number Information
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NPI Number | 1972854370
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Entity Type | Organization
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Legal Business Name | AGING RESOURCES
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 7710 NE VANCOUVER MALL DR STE C
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City | VANCOUVER
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State | WA
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Zip | 98662-6485
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Country | US
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Telephone | 360-574-5293
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Fax | 360-574-7824
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Provider Business Mailing Address
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Address Line | 7710 NE VANCOUVER MALL DR STE C
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City | VANCOUVER
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State | WA
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Zip | 98662-6485
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Country | US
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Telephone | 360-574-5293
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Fax | 360-574-7824
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GAIL HASKETT
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Credential |
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Telephone | 360-574-5293
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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 | 602-412-767
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License Number State | WA
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