1821276759 NPI number — MB2K, LLC

Table of content: (NPI 1821276759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821276759 NPI number — MB2K, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MB2K, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILYCARE OF KENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821276759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10024 SE 240TH ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98031-5124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-859-2273
Provider Business Mailing Address Fax Number:
253-850-8894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10024 SE 240TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98031-5124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-859-2273
Provider Business Practice Location Address Fax Number:
253-850-8894
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILEY
Authorized Official First Name:
MADELINE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
253-859-2273

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  AP30001318 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9626888 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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