Provider Demographics
NPI:1851519524
Name:SNO-VALLEY ADULT DAY HEALTH
Entity Type:Organization
Organization Name:SNO-VALLEY ADULT DAY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:YEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-333-4152
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:4610 STEPHENS AVE
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-0096
Mailing Address - Country:US
Mailing Address - Phone:425-333-4152
Mailing Address - Fax:425-333-4465
Practice Address - Street 1:4610 STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014
Practice Address - Country:US
Practice Address - Phone:425-333-4152
Practice Address - Fax:425-333-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA993186Medicaid