Provider Demographics
NPI:1093406316
Name:ST PETER HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ST PETER HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:WACHUKA
Authorized Official - Last Name:WAITHAKA
Authorized Official - Suffix:
Authorized Official - Credentials:NAC
Authorized Official - Phone:253-341-9642
Mailing Address - Street 1:10828 GRAVELLY LAKE DR SW STE 109
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1300
Mailing Address - Country:US
Mailing Address - Phone:253-433-3908
Mailing Address - Fax:253-267-0358
Practice Address - Street 1:10828 GRAVELLY LAKE DR SW STE 109
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1300
Practice Address - Country:US
Practice Address - Phone:253-433-3908
Practice Address - Fax:253-267-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385HR2050XRespite Care FacilityRespite CareRespite Care CampGroup - Single Specialty