Provider Demographics
NPI:1407863475
Name:CAROLINE KLINE GALLAND HOME
Entity Type:Organization
Organization Name:CAROLINE KLINE GALLAND HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-725-8800
Mailing Address - Street 1:7500 SEWARD PARK AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4247
Mailing Address - Country:US
Mailing Address - Phone:206-725-8800
Mailing Address - Fax:206-722-5210
Practice Address - Street 1:7500 SEWARD PARK AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4247
Practice Address - Country:US
Practice Address - Phone:206-725-8800
Practice Address - Fax:206-722-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH658314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4165809Medicaid
WA4165809Medicaid