Provider Demographics
NPI:1720401508
Name:IMBA LLC
Entity Type:Organization
Organization Name:IMBA LLC
Other - Org Name:A WATER VIEW ADULT FAMILY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IOANA
Authorized Official - Middle Name:RALUCA
Authorized Official - Last Name:BOANCA
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:206-697-5557
Mailing Address - Street 1:PO BOX 2566
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98083-2566
Mailing Address - Country:US
Mailing Address - Phone:206-697-5557
Mailing Address - Fax:206-629-5544
Practice Address - Street 1:19511 23 RD AVE NW
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2566
Practice Address - Country:US
Practice Address - Phone:206-697-5557
Practice Address - Fax:206-629-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA752552311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home