Provider Demographics
NPI:1104544881
Name:PNW AGING SPECIALTY SERVICES, LLC
Entity type:Organization
Organization Name:PNW AGING SPECIALTY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:YOURCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:503-488-0318
Mailing Address - Street 1:7720 NE VANCOUVER MALL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-7918
Mailing Address - Country:US
Mailing Address - Phone:360-883-3569
Mailing Address - Fax:360-883-3568
Practice Address - Street 1:7720 NE VANCOUVER MALL DR STE 110
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-7918
Practice Address - Country:US
Practice Address - Phone:360-883-3569
Practice Address - Fax:360-883-3568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty