Provider Demographics
NPI:1386989614
Name:CITRINE HEALTH
Entity type:Organization
Organization Name:CITRINE HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MALLAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:425-259-9899
Mailing Address - Street 1:2940 W MARINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3926
Mailing Address - Country:US
Mailing Address - Phone:425-259-9899
Mailing Address - Fax:425-259-9880
Practice Address - Street 1:2940 W MARINE VIEW DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3926
Practice Address - Country:US
Practice Address - Phone:425-259-9899
Practice Address - Fax:425-259-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601707825251V00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7379570001Medicare NSC