MEDICARE: ALLEVA HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	IHS.FS.00000123	WA

General Provider Information

NPI Number	:	1295001253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEVA HOME CARE

Provider Business Mailing Address
First Line	:	1511 THIRD AVE.
Second Line	:	SUITE 308
City	:	SEATTLE
State	:	WA
Zip	:	98101-1683
Country	:	US
Telephone Number	:	206-957-1365
Fax Number	:	206-382-4234

Provider Business Practice Location Address
First Line	:	1511 THIRD AVE
Second Line	:	SUITE 308
City	:	SEATTLE
State	:	WA
Zip	:	98101-1683
Country	:	US
Telephone Number	:	206-957-1365
Fax Number	:	206-382-4234

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. NISON BORIS SIMONTOV
Credential	:	J.D.
Telephone Number	:	206-957-1365

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	03/23/2012

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