Provider Demographics
NPI:1962547729
Name:SERENA M. BARCHA, INC.
Entity type:Organization
Organization Name:SERENA M. BARCHA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MS
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BARCHA
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-232-8854
Mailing Address - Street 1:619 97TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-3910
Mailing Address - Country:US
Mailing Address - Phone:425-232-8854
Mailing Address - Fax:425-335-4328
Practice Address - Street 1:619 97TH AVE SE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-3910
Practice Address - Country:US
Practice Address - Phone:425-232-8854
Practice Address - Fax:425-335-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006941305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherEIN