Provider Demographics
NPI:1033662309
Name:ACREN HEALTH CARE INC
Entity Type:Organization
Organization Name:ACREN HEALTH CARE INC
Other - Org Name:ACREN HEALTH CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-845-5622
Mailing Address - Street 1:PO BOX 65161
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-9161
Mailing Address - Country:US
Mailing Address - Phone:888-845-5622
Mailing Address - Fax:
Practice Address - Street 1:21713 80TH AVE W
Practice Address - Street 2:2
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7808
Practice Address - Country:US
Practice Address - Phone:888-845-5622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
164W00000X, 251C00000X, 251E00000X, 251X00000X, 302R00000X, 343900000X, 3747A0650X
WANR00000586251J00000X
WA347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251X00000XAgenciesSupports Brokerage
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty