Provider Demographics
NPI:1316236144
Name:NORTHAVEN ASSISTED LIVING
Entity type:Organization
Organization Name:NORTHAVEN ASSISTED LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:STORTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-365-3020
Mailing Address - Street 1:11045 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6163
Mailing Address - Country:US
Mailing Address - Phone:206-365-3020
Mailing Address - Fax:206-365-0267
Practice Address - Street 1:11045 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6163
Practice Address - Country:US
Practice Address - Phone:206-365-3020
Practice Address - Fax:206-365-0267
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHAVEN INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABH980310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility