Provider Demographics
NPI:1851661888
Name:CORDIAL COMPLETE CARE
Entity Type:Organization
Organization Name:CORDIAL COMPLETE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CRACIUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-221-0395
Mailing Address - Street 1:503 225TH LN NE
Mailing Address - Street 2:NUMBER 304
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7171
Mailing Address - Country:US
Mailing Address - Phone:425-221-0395
Mailing Address - Fax:425-996-0241
Practice Address - Street 1:503 225TH LN NE
Practice Address - Street 2:NUMBER 304
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7171
Practice Address - Country:US
Practice Address - Phone:425-221-0395
Practice Address - Fax:425-996-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603015139253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care