Provider Demographics
NPI:1578687240
Name:MARY CATHERINES & DAUGHTERS
Entity Type:Organization
Organization Name:MARY CATHERINES & DAUGHTERS
Other - Org Name:MARY CATHERINE'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:MARIAN
Authorized Official - Last Name:RIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-322-1128
Mailing Address - Street 1:10002 AURORA AVE N
Mailing Address - Street 2:BLDG. 2, SUITE 12-14
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9329
Mailing Address - Country:US
Mailing Address - Phone:206-322-1128
Mailing Address - Fax:206-322-9239
Practice Address - Street 1:10002 AURORA AVE N
Practice Address - Street 2:BLDG. 2, SUITE 12-14
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9329
Practice Address - Country:US
Practice Address - Phone:206-322-1128
Practice Address - Fax:206-322-9239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR151602332B00000X
WA600309023332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035MAOtherREGENCE
OR018994Medicaid
WA1074MAOtherREGENCE
WA9013269Medicaid
WA9558107Medicaid
WA0262910003Medicare NSC