Provider Demographics
NPI:1790467850
Name:THE VILLAGE- A MUSTARD SEED PROJECT
Entity Type:Organization
Organization Name:THE VILLAGE- A MUSTARD SEED PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:MELENDEZ BLEGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-884-1205
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:VAUGHN
Mailing Address - State:WA
Mailing Address - Zip Code:98394-0182
Mailing Address - Country:US
Mailing Address - Phone:253-884-9814
Mailing Address - Fax:
Practice Address - Street 1:9115 154TH AVENUE CT NW
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-9850
Practice Address - Country:US
Practice Address - Phone:253-900-9936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MUSTARD SEED PROJECT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility