Organization Name: | HAZEL DELL VENTURES LLC |
NPI Number: | 1447387626 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREGORY J VISLOCKY (MANAGING MEMBER) |
Mailing Address: | 7514 Ne 13th Ave Vancouver |
State: | WA US |
Postal Code: | 986650458 |
Phone Number: | 3606932402 |
Fax Number: | 3606935011 |
NPI Enumeration Date: | 02/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | BH 1615 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |