Organization
CHILDREN' S COUNTRY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE KOLB (EXECUTIVE DIRECTOR)
(425) 806-9453
Entity
Organization
Contact information
Practice address
14643 NE 166TH ST, WOODINVILLE, WA 98072-9013
(425) 806-9453
(425) 485-1527
Mailing address
14643 NE 166TH ST, WOODINVILLE, WA 98072-9013
(425) 806-9453
(425) 485-1527
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
IS-253
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011272
HOME HEALTH ID
WA
01
—
518840
PEDIATRIC GROUP HOME LIC.
WA
Enumeration date
03/06/2007
Last updated
08/22/2020
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