Organization
FULL LIFE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NORA GIBSON MSW (EXECUTIVE DIRECTOR)
(206) 467-7033
Entity
Organization
Contact information
Practice address
2931 RUKER AVE., EVERETT, WA 98201
(425) 355-1313
(425) 348-3012
Mailing address
4712 35TH AVE S, SEATTLE, WA 98118-1704
(206) 467-7033
(206) 224-3779
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
251E00000X
Home Health Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
501965
DSHS PROVIDER #
WA
Enumeration date
11/01/2012
Last updated
02/09/2021
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