1811270838 NPI number — ACCLAIM BODY CARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811270838 NPI number — ACCLAIM BODY CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCLAIM BODY CARE LLC
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:
1811270838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 33185
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHORELINE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98133-0185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-715-1318
Provider Business Mailing Address Fax Number:
206-402-6548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17517 15TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98155-3801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-715-1318
Provider Business Practice Location Address Fax Number:
206-402-6548
Provider Enumeration Date:
09/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ACOSTA-DRAKE
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
206-715-1318

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA 00015223 , 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)





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