Provider Demographics
NPI:1245029693
Name:JORGE ALEXANDER FLOREZ
Entity type:Organization
Organization Name:JORGE ALEXANDER FLOREZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLOREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-750-5803
Mailing Address - Street 1:16000 75TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4524
Mailing Address - Country:US
Mailing Address - Phone:425-750-5803
Mailing Address - Fax:
Practice Address - Street 1:17734 2ND PL NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-3504
Practice Address - Country:US
Practice Address - Phone:425-750-5803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home