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Nursing Service Related Providers Chore Provider

Provider NPI: 1205007788

Organization Information:
Organization is not Subpart
Authorized Official:  THOR  KELLY  ADMINISTRATOR  360-696-0534

Practice Location:
Tel: 360-696-0534  Fax: 360-694-6830

Business Mailing Address:
PO BOX 2583  VANCOUVER, WA 98668-2583 US
Tel: 360-696-0534  Fax: 360-694-6830

NPI Information:
NPI: 1205007788
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y372500000XNursing Service Related Providers
Chore Provider

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 372500000X





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