Provider Demographics
NPI: | 1457995821 |
---|---|
Name: | KIRKLAND MEMORY CARE, LLC |
Entity Type: | Organization |
Organization Name: | KIRKLAND MEMORY CARE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | EMMETT |
Authorized Official - Middle Name: | AARON |
Authorized Official - Last Name: | KOELSCH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 360-867-1900 |
Mailing Address - Street 1: | 111 MARKET ST NE STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | OLYMPIA |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98501-1008 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 360-867-1900 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 12217 NE 128TH ST |
Practice Address - Street 2: | |
Practice Address - City: | KIRKLAND |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98034-7301 |
Practice Address - Country: | US |
Practice Address - Phone: | 425-202-7254 |
Practice Address - Fax: | 425-307-1291 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-10-29 |
Last Update Date: | 2019-10-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
No | 311500000X | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) |