Provider Demographics
NPI:1396130167
Name:CROWN ASSISTED LIVING DEVELOPMENT
Entity type:Organization
Organization Name:CROWN ASSISTED LIVING DEVELOPMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,MA
Authorized Official - Phone:253-779-3800
Mailing Address - Street 1:1609 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1937
Mailing Address - Country:US
Mailing Address - Phone:253-779-3800
Mailing Address - Fax:253-779-3822
Practice Address - Street 1:1609 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1937
Practice Address - Country:US
Practice Address - Phone:253-779-3800
Practice Address - Fax:253-779-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601457699310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility