1982920112 NPI number — AHC OF BOTHELL 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 1982920112 NPI number — AHC OF BOTHELL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHC OF BOTHELL 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:
ADVANCED HEALTH CARE OF BOTHELL
Provider Other Organization Name Type Code:
3
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:
1982920112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 N WHITLEY DR
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
FRUITLAND
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83619-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-452-6392
Provider Business Mailing Address Fax Number:
208-452-2234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 228TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98021-9733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-481-8500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
EMMETT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
253-670-5700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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