Provider Demographics
NPI:1528584042
Name:IMMACULATE INDEPENDENT LIVING, LLC
Entity Type:Organization
Organization Name:IMMACULATE INDEPENDENT LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMMACULATE
Authorized Official - Middle Name:
Authorized Official - Last Name:NABAWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-694-9068
Mailing Address - Street 1:1615 19TH AVE APT A225
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-7508
Mailing Address - Country:US
Mailing Address - Phone:206-694-9068
Mailing Address - Fax:
Practice Address - Street 1:1615 19TH STREET
Practice Address - Street 2:SUITE A225
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-7508
Practice Address - Country:US
Practice Address - Phone:206-694-9068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health