Provider Demographics
NPI:1295001253
Name:ALLEVA HOME CARE
Entity Type:Organization
Organization Name:ALLEVA HOME CARE
Other - Org Name:ALLEVA HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NISON
Authorized Official - Middle Name:BORIS
Authorized Official - Last Name:SIMONTOV
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:206-957-1365
Mailing Address - Street 1:1511 THIRD AVE.
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1683
Mailing Address - Country:US
Mailing Address - Phone:206-957-1365
Mailing Address - Fax:206-382-4234
Practice Address - Street 1:1511 THIRD AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1683
Practice Address - Country:US
Practice Address - Phone:206-957-1365
Practice Address - Fax:206-382-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000123253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care