Provider Demographics
NPI:1497949556
Name:AAA RESIDENTIAL SERVICES INC.
Entity Type:Organization
Organization Name:AAA RESIDENTIAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-261-3999
Mailing Address - Street 1:9027 PACIFIC AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-6247
Mailing Address - Country:US
Mailing Address - Phone:800-774-0210
Mailing Address - Fax:253-539-2805
Practice Address - Street 1:9027 PACIFIC AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-6247
Practice Address - Country:US
Practice Address - Phone:800-774-0210
Practice Address - Fax:253-539-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA319658251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA319658Medicaid