Provider Demographics
NPI:1548045552
Name:DECORUM PRIVATE HEALTHCARE LLC
Entity type:Organization
Organization Name:DECORUM PRIVATE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAWAPA
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:BUKENYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-650-0517
Mailing Address - Street 1:11030 7TH AVE SE APT E219
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4072
Mailing Address - Country:US
Mailing Address - Phone:206-650-0517
Mailing Address - Fax:800-475-9684
Practice Address - Street 1:11030 7TH AVE SE APT E219
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4072
Practice Address - Country:US
Practice Address - Phone:206-650-0517
Practice Address - Fax:800-475-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty