Provider Demographics
NPI:1114026648
Name:PACIFIC HANDWORKS INC., P.S.
Entity Type:Organization
Organization Name:PACIFIC HANDWORKS INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:425-827-5877
Mailing Address - Street 1:2800 NORTHUP WAY
Mailing Address - Street 2:#200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1440
Mailing Address - Country:US
Mailing Address - Phone:425-827-5877
Mailing Address - Fax:425-827-5843
Practice Address - Street 1:2800 NORTHUP WAY
Practice Address - Street 2:#200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1440
Practice Address - Country:US
Practice Address - Phone:425-827-5877
Practice Address - Fax:425-827-5843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000695261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5477383OtherAETNA
WAVA0026OtherREGENCE
WA8340119Medicaid
WA0000026062702OtherUNITED HEALTHCARE
WA55951OtherDEPT OF LABOR & INDUSTRIE
WA8340119Medicaid
WA0591260001Medicare NSC