Provider Demographics
NPI:1467574855
Name:ADULTCARE OF RENTON
Entity Type:Organization
Organization Name:ADULTCARE OF RENTON
Other - Org Name:PASSPORT HEALTH W. WASHINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-251-0205
Mailing Address - Street 1:3900 E VALLEY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4954
Mailing Address - Country:US
Mailing Address - Phone:425-251-0205
Mailing Address - Fax:
Practice Address - Street 1:3900 E VALLEY RD
Practice Address - Street 2:STE 101
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4954
Practice Address - Country:US
Practice Address - Phone:425-251-0205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602164615261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty