Provider Demographics
NPI:1932327640
Name:MICA HOMES
Entity Type:Organization
Organization Name:MICA HOMES
Other - Org Name:5TH AVENUE TOUCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-686-1609
Mailing Address - Street 1:911 5TH AVE SE STE 201
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1534
Mailing Address - Country:US
Mailing Address - Phone:253-686-1609
Mailing Address - Fax:360-352-9391
Practice Address - Street 1:911 5TH AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1505
Practice Address - Country:US
Practice Address - Phone:253-686-1609
Practice Address - Fax:
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?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty