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General NPI Number Information
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NPI Number | 1972940815
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Entity Type | Organization
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Legal Business Name | SANDRA CARE
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Dates
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Enumeration Date | 06/02/2013
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Last Update Date | 06/02/2013
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Provider Practice Location Address
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Address Line | 1215 S TOWER AVE
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City | CENTRALIA
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State | WA
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Zip | 98531-2338
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Country | US
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Telephone | 360-807-4237
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 S TOWER AVE
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City | CENTRALIA
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State | WA
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Zip | 98531-2338
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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 | R.N., ADMINISTRATOR
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Name | MR. DENNIS GRIFFIN
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Credential |
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Telephone | 360-807-4237
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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 | 2173
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License Number State | WA
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