MEDICARE: CENTER FOR INDEPENDENCE

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	251B00000X	Case Management Agency	601439153	WA

General Provider Information

NPI Number	:	1730571803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR INDEPENDENCE

Provider Business Mailing Address
First Line	:	7801 BRIDGEPORT WAY W
Second Line	:	SUITE 200
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-8440
Country	:	US
Telephone Number	:	253-582-1253
Fax Number	:	253-584-4374

Provider Business Practice Location Address
First Line	:	7801 BRIDGEPORT WAY W
Second Line	:	SUITE 200
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-8440
Country	:	US
Telephone Number	:	253-582-1253
Fax Number	:	253-584-4374

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. PATRICIA A KOSIER
Credential	:
Telephone Number	:	253-582-1253

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	02/26/2015

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