Provider Demographics
NPI:1225446453
Name:ELDER AND ADULT DAY SERVICES
Entity Type:Organization
Organization Name:ELDER AND ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPA
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-271-0167
Mailing Address - Street 1:12831 NE 21ST PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1909
Mailing Address - Country:US
Mailing Address - Phone:425-250-7038
Mailing Address - Fax:
Practice Address - Street 1:12831 NE 21ST PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1909
Practice Address - Country:US
Practice Address - Phone:425-250-7038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251C00000X385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA501954Medicaid