1639368301 NPI number — ABUNDANT LIFE HEALTH CENTER, INC.

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 1639368301 NPI number — ABUNDANT LIFE HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABUNDANT LIFE HEALTH 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:
1639368301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22002 64TH AVE W
Provider Second Line Business Mailing Address:
SUITE 2E
Provider Business Mailing Address City Name:
MOUNTLAKE TERRACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98043-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-774-7982
Provider Business Mailing Address Fax Number:
425-672-4464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22002 64TH AVE W
Provider Second Line Business Practice Location Address:
SUITE 2E
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-774-7982
Provider Business Practice Location Address Fax Number:
425-672-4464
Provider Enumeration Date:
10/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
MARY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
425-774-7982

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00002908 , 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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