Provider Demographics
NPI:1053163618
Name:STALOCO HOUSE LLC
Entity type:Organization
Organization Name:STALOCO HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-649-0234
Mailing Address - Street 1:PO BOX 18711
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-0711
Mailing Address - Country:US
Mailing Address - Phone:206-649-0234
Mailing Address - Fax:
Practice Address - Street 1:11403 SE 208TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1659
Practice Address - Country:US
Practice Address - Phone:206-649-0234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management