Provider Demographics
NPI:1952794034
Name:SENIOR LIFE RESOURCES NORTHWEST
Entity Type:Organization
Organization Name:SENIOR LIFE RESOURCES NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-735-1911
Mailing Address - Street 1:8656 W GAGE BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7145
Mailing Address - Country:US
Mailing Address - Phone:509-735-1911
Mailing Address - Fax:
Practice Address - Street 1:8656 W GAGE BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7145
Practice Address - Country:US
Practice Address - Phone:509-735-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000434253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care