Provider Demographics
NPI:1568800035
Name:VIERCK LTD
Entity Type:Organization
Organization Name:VIERCK LTD
Other - Org Name:CANYON CREEK ADULT FAMILY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:VIERCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:360-907-3997
Mailing Address - Street 1:22918 NE 169TH ST
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-8716
Mailing Address - Country:US
Mailing Address - Phone:360-907-3997
Mailing Address - Fax:
Practice Address - Street 1:22918 NE 169TH ST
Practice Address - Street 2:
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606-8716
Practice Address - Country:US
Practice Address - Phone:360-907-3997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA456900311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home