Provider Demographics
NPI:1396589578
Name:CORDIAL PALACE AFH LLC
Entity type:Organization
Organization Name:CORDIAL PALACE AFH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PURITY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-226-4800
Mailing Address - Street 1:9001 RIDGEVIEW CIR W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-1334
Mailing Address - Country:US
Mailing Address - Phone:253-226-4800
Mailing Address - Fax:
Practice Address - Street 1:9001 RIDGEVIEW CIR W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-1334
Practice Address - Country:US
Practice Address - Phone:253-226-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home