Provider Demographics
NPI:1356630305
Name:KING COUNTY ELDER SERVICE CENTER
Entity Type:Organization
Organization Name:KING COUNTY ELDER SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABSHIR
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:MAHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-307-5929
Mailing Address - Street 1:17440 103RD AVE SE UNIT C202
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5425
Mailing Address - Country:US
Mailing Address - Phone:206-307-5929
Mailing Address - Fax:
Practice Address - Street 1:4712 35TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1704
Practice Address - Country:US
Practice Address - Phone:206-307-6268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care