Provider Demographics
NPI:1447079827
Name:EAST TO WEST AGING SERVICES & CONSULTING LLC
Entity type:Organization
Organization Name:EAST TO WEST AGING SERVICES & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENCKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-243-8152
Mailing Address - Street 1:1947 N PRAIRIE LN UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9252
Mailing Address - Country:US
Mailing Address - Phone:564-243-8152
Mailing Address - Fax:
Practice Address - Street 1:1947 N PRAIRIE LN UNIT 103
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9252
Practice Address - Country:US
Practice Address - Phone:434-907-0136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes251B00000XAgenciesCase Management