Provider Demographics
NPI:1265852511
Name:BELICINA, GINA N (AFH/PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:N
Last Name:BELICINA
Suffix:
Gender:F
Credentials:AFH/PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11180 BEACON AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2145
Mailing Address - Country:US
Mailing Address - Phone:206-407-5210
Mailing Address - Fax:206-760-6285
Practice Address - Street 1:11180 BEACON AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-2145
Practice Address - Country:US
Practice Address - Phone:206-407-5210
Practice Address - Fax:206-760-6285
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA751480311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home