Provider Demographics
NPI:1235148081
Name:NORSE HOME
Entity Type:Organization
Organization Name:NORSE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF HUMAN RESOURCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVENDRA
Authorized Official - Middle Name:VIJAY
Authorized Official - Last Name:RAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-781-7400
Mailing Address - Street 1:5311 PHINNEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6030
Mailing Address - Country:US
Mailing Address - Phone:206-781-7400
Mailing Address - Fax:206-781-7558
Practice Address - Street 1:5311 PHINNEY AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6030
Practice Address - Country:US
Practice Address - Phone:206-781-7400
Practice Address - Fax:206-781-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA145310400000X
WA410310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4141008Medicaid
WA4142001OtherDEPT. OF REVENUE
WA4141008Medicaid