Provider Demographics
NPI:1417267345
Name:PAIGE SUSAN LLC
Entity Type:Organization
Organization Name:PAIGE SUSAN LLC
Other - Org Name:SYNERGY HOMECARE SEATTLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGIBBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-420-4934
Mailing Address - Street 1:5501 4TH AVE S
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2447
Mailing Address - Country:US
Mailing Address - Phone:206-420-4934
Mailing Address - Fax:206-257-0372
Practice Address - Street 1:5501 4TH AVE S
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2447
Practice Address - Country:US
Practice Address - Phone:206-420-4934
Practice Address - Fax:206-257-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.60151137253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care