1922279686 NPI number — JOLLY WAY HEALTH INC., P.S. DBA MERCER WELLNESS

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 1922279686 NPI number — JOLLY WAY HEALTH INC., P.S. DBA MERCER WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOLLY WAY HEALTH INC., P.S. DBA MERCER WELLNESS
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:
1922279686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7605 SE 27TH ST
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
MERCER ISLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98040-2835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-275-4870
Provider Business Mailing Address Fax Number:
206-275-4876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7605 SE 27TH ST
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
MERCER ISLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98040-2835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-275-4870
Provider Business Practice Location Address Fax Number:
206-275-4876
Provider Enumeration Date:
03/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JOLLY
Authorized Official First Name:
FARRELL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
206-275-4870

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00034804 , 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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