Basic Information
| Provider Information | |||||||||
| NPI: | 1790182053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALASKA GARDENS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2549 S MERIDIAN | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983732753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583364376 | ||||||||
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| Address1: | 2549 S MERIDIAN | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983732753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583364376 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2014 | ||||||||
| LastUpdateDate: | 12/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | NATRECE | ||||||||
| AuthorizedOfficialMiddleName: | NICKISHA | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8583364376 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEALTH AND REHABILITATION | ||||||||
| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | MED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | LL60026338 | WA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.