Provider Demographics
NPI:1891196911
Name:L-CAM CORPORATION
Entity Type:Organization
Organization Name:L-CAM CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:AMONDSON-MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:360-740-7431
Mailing Address - Street 1:102 PINE DR
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-9633
Mailing Address - Country:US
Mailing Address - Phone:360-740-7431
Mailing Address - Fax:
Practice Address - Street 1:102 PINE DR
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-9633
Practice Address - Country:US
Practice Address - Phone:360-740-7431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA750224311ZA0620X
WA750937311ZA0620X
WA752154311ZA0620X
WA752683311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA603123506Medicaid