Provider Demographics
NPI:1508854944
Name:AH, LLC
Entity Type:Organization
Organization Name:AH, LLC
Other - Org Name:ANDERSON HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATIKO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:206-364-7131
Mailing Address - Street 1:17127 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5127
Mailing Address - Country:US
Mailing Address - Phone:206-364-7131
Mailing Address - Fax:206-361-8262
Practice Address - Street 1:17127 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5127
Practice Address - Country:US
Practice Address - Phone:206-364-7131
Practice Address - Fax:206-361-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH 1328314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA603094005OtherGROUP HEALTH
WA603094005OtherGROUP HEALTH