Provider Demographics
NPI:1972994192
Name:MAMA CHRISTINES SAUCE&BOWLS
Entity type:Organization
Organization Name:MAMA CHRISTINES SAUCE&BOWLS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:IAVARONE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-463-0728
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-1239
Mailing Address - Country:US
Mailing Address - Phone:206-463-0728
Mailing Address - Fax:
Practice Address - Street 1:9925 SW 178TH STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4222
Practice Address - Country:US
Practice Address - Phone:206-463-0728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Single Specialty