Provider Demographics
NPI:1689805368
Name:SEATTLE CHINATOWN INTERNATIONAL DISTRICT PRESERVATION & DEVELOPMENT AU
Entity Type:Organization
Organization Name:SEATTLE CHINATOWN INTERNATIONAL DISTRICT PRESERVATION & DEVELOPMENT AU
Other - Org Name:LEGACY HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-838-8231
Mailing Address - Street 1:803 S LANE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3044
Mailing Address - Country:US
Mailing Address - Phone:206-292-5184
Mailing Address - Fax:206-838-3057
Practice Address - Street 1:803 S LANE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3044
Practice Address - Country:US
Practice Address - Phone:206-292-5184
Practice Address - Fax:206-838-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABH1203310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9050097Medicaid
WA9050097Medicaid