Provider Demographics
NPI:1225469349
Name:MACE, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N 18TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1762
Mailing Address - Country:US
Mailing Address - Phone:503-396-2788
Mailing Address - Fax:
Practice Address - Street 1:255 N 18TH ST APT 4
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1762
Practice Address - Country:US
Practice Address - Phone:503-396-2788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-30
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR993550314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility