Provider Demographics
NPI:1376974188
Name:PILGRIM CARE INC.
Entity Type:Organization
Organization Name:PILGRIM CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:SATRIAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-517-3130
Mailing Address - Street 1:402 S 333RD ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6309
Mailing Address - Country:US
Mailing Address - Phone:253-517-3130
Mailing Address - Fax:877-260-6243
Practice Address - Street 1:402 S 333RD ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6309
Practice Address - Country:US
Practice Address - Phone:253-517-3130
Practice Address - Fax:877-260-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60388762253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care