Provider Demographics
NPI:1790182053
Name:ALASKA GARDENS
Entity Type:Organization
Organization Name:ALASKA GARDENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:NATRECE
Authorized Official - Middle Name:NICKISHA
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:858-336-4376
Mailing Address - Street 1:2549 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-2753
Mailing Address - Country:US
Mailing Address - Phone:858-336-4376
Mailing Address - Fax:
Practice Address - Street 1:2549 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-2753
Practice Address - Country:US
Practice Address - Phone:858-336-4376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH AND REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60026338314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility