Provider Demographics
NPI:1285382390
Name:LIFECENTER NORTHWEST
Entity type:Organization
Organization Name:LIFECENTER NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE AND ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-201-6604
Mailing Address - Street 1:3650 131ST AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1395
Mailing Address - Country:US
Mailing Address - Phone:877-275-5269
Mailing Address - Fax:
Practice Address - Street 1:3650 131ST AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1395
Practice Address - Country:US
Practice Address - Phone:877-275-5269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335U00000XSuppliersOrgan Procurement Organization