Provider Demographics
NPI:1457793754
Name:CATHERINE DAMBROSIO PHD RN &
Entity type:Organization
Organization Name:CATHERINE DAMBROSIO PHD RN &
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:V
Authorized Official - Last Name:DAMBROSIO
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MS, CDR
Authorized Official - Phone:206-420-3484
Mailing Address - Street 1:2026 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3335
Mailing Address - Country:US
Mailing Address - Phone:206-420-3484
Mailing Address - Fax:
Practice Address - Street 1:2026 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3335
Practice Address - Country:US
Practice Address - Phone:206-420-3484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-27
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.60318430251E00000X, 251J00000X
WA1065189313M00000X, 3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1065189OtherDSHS CHILDREN'S AGENCY GROUP HOME LICENSE