Provider Demographics
NPI:1114316494
Name:WASHINGTON CARE AFH
Entity Type:Organization
Organization Name:WASHINGTON CARE AFH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TANTOCO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:206-801-7174
Mailing Address - Street 1:147 NW 183RD ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3439
Mailing Address - Country:US
Mailing Address - Phone:206-801-7174
Mailing Address - Fax:206-801-7470
Practice Address - Street 1:16603 190TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-0814
Practice Address - Country:US
Practice Address - Phone:425-282-4127
Practice Address - Fax:206-801-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7509293747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty