Provider Demographics
NPI:1073016846
Name:PCJ ENTERPRISES LLC
Entity Type:Organization
Organization Name:PCJ ENTERPRISES LLC
Other - Org Name:FIRSTLIGHT HOME CARE EASTSIDE SEATTLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-968-5357
Mailing Address - Street 1:733 7TH AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5657
Mailing Address - Country:US
Mailing Address - Phone:425-968-5357
Mailing Address - Fax:425-298-4659
Practice Address - Street 1:733 7TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5657
Practice Address - Country:US
Practice Address - Phone:425-968-5357
Practice Address - Fax:425-298-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-17
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60796571253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care