1104967827 NPI number — SOUND HEALTH AND WELLNESS CENTER INC.

Table of content: (NPI 1104967827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104967827 NPI number — SOUND HEALTH AND WELLNESS CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUND HEALTH AND WELLNESS CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104967827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19735 10TH AVE NE
Provider Second Line Business Mailing Address:
SUITE S102
Provider Business Mailing Address City Name:
POULSBO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98370-7693
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-779-5461
Provider Business Mailing Address Fax Number:
360-779-6182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19735 10TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE S102
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-7693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-779-5461
Provider Business Practice Location Address Fax Number:
360-779-6182
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHLIFER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-779-5461

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD00035541 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1102250 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com