Provider Demographics
NPI:1710747415
Name:LINDEN HOUSE
Entity Type:Organization
Organization Name:LINDEN HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVANEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-852-6219
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:WA
Mailing Address - Zip Code:98591-0999
Mailing Address - Country:US
Mailing Address - Phone:360-355-3617
Mailing Address - Fax:
Practice Address - Street 1:404 SE 1ST STREET
Practice Address - Street 2:
Practice Address - City:WINLOCK
Practice Address - State:WA
Practice Address - Zip Code:98596
Practice Address - Country:US
Practice Address - Phone:360-355-3617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care