Provider Demographics
NPI:1457995821
Name:KIRKLAND MEMORY CARE, LLC
Entity type:Organization
Organization Name:KIRKLAND MEMORY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMETT
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:KOELSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-867-1900
Mailing Address - Street 1:111 MARKET ST NE STE 200
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1008
Mailing Address - Country:US
Mailing Address - Phone:360-867-1900
Mailing Address - Fax:
Practice Address - Street 1:12217 NE 128TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7301
Practice Address - Country:US
Practice Address - Phone:425-202-7254
Practice Address - Fax:425-307-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)