Provider Demographics
NPI:1609640176
Name:LORENE'S PLACE II
Entity Type:Organization
Organization Name:LORENE'S PLACE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:T
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-353-6078
Mailing Address - Street 1:3819 100TH ST SW STE 8A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4477
Mailing Address - Country:US
Mailing Address - Phone:253-759-3650
Mailing Address - Fax:253-759-3651
Practice Address - Street 1:11150 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1349
Practice Address - Country:US
Practice Address - Phone:253-531-3462
Practice Address - Fax:253-759-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management