Organization
PARADISE LAKE SENIOR CARE HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA FRIGILLANA RN, BSN (AFH PROVIDER)
(425) 761-7739
Entity
Organization
Contact information
Practice address
10121 219TH ST SE, SNOHOMISH, WA 98296-4941
(425) 761-7739
(360) 668-5297
Mailing address
10121 219TH ST SE, SNOHOMISH, WA 98296-4941
(425) 761-7739
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
751477
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
515305
—
WA
Enumeration date
08/15/2014
Last updated
08/15/2014
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