Provider Demographics
NPI:1114411691
Name:GASSELING HOUSE ADF
Entity Type:Organization
Organization Name:GASSELING HOUSE ADF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:GASSELING
Authorized Official - Suffix:
Authorized Official - Credentials:AFH
Authorized Official - Phone:509-248-8584
Mailing Address - Street 1:905 BEAUDRY RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-8104
Mailing Address - Country:US
Mailing Address - Phone:509-248-8584
Mailing Address - Fax:509-577-8525
Practice Address - Street 1:905 BEAUDRY RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-8104
Practice Address - Country:US
Practice Address - Phone:509-248-8584
Practice Address - Fax:509-577-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA252400251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA252400OtherSTATE LICENSES