Organization
MADRONA PEAK LLC
Active
Other names
Generations Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB T GAMBLE (MEMBER)
(509) 251-3016
Entity
Organization
Contact information
Practice address
6430 TACOMA MALL BLVD STE 201, TACOMA, WA 98409-6700
(253) 693-4092
(253) 204-3568
Mailing address
6430 TACOMA MALL BLVD STE 201, TACOMA, WA 98409-6700
(253) 693-4092
(253) 204-3568
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IHS.FS.60603640
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
07/21/2022
Last updated
07/21/2022
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