Provider Demographics
NPI:1619367216
Name:PERDE, CORNEL AUREL
Entity Type:Individual
Prefix:
First Name:CORNEL
Middle Name:AUREL
Last Name:PERDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13205 SE 160TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7807
Mailing Address - Country:US
Mailing Address - Phone:425-687-9380
Mailing Address - Fax:425-793-6462
Practice Address - Street 1:13205 SE 160TH PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7807
Practice Address - Country:US
Practice Address - Phone:425-687-9380
Practice Address - Fax:425-793-6462
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA730100311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home