Organization
PROVIDENCE SENIOR HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SANDU CODREANU NAC (OWNER/PROVIDER)
(509) 638-8738
Entity
Organization
Contact information
Practice address
3623 W INDIAN TRAIL RD, SPOKANE, WA 99208
(509) 710-2776
Mailing address
3623 W INDIAN TRAIL RD, SPOKANE, WA 99208-4733
(509) 638-8738
(509) 326-6468
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
A752165
WA
Other
Enumeration date
09/05/2014
Last updated
09/05/2014
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