Most Relevant Information
Provider Data
| NPI Number: | 1003362328 |
| Provider Name: | VLADIMIR KUKSENKO |
| Entity Type: | Individual |
| Taxonomy Code: | 320700000X |
| Specialty: | Residential Treatment Facility, Physical Disabilities |
| License Number: | 60525301 |
Most Important Dates
| Enumeration Date: | 08/28/2016 |
| Last Updated: | 08/28/2016 |
Provider Practice Location
1958 EATON AVE
FERNDALE
WA
982489709
Practice Location Phone/Fax
| Phone: | 3603185636 |
| Fax: |
Provider Mailing Location
1958 EATON AVE
FERNDALE
WA
98248
Provider Mailing Phone/Fax
| Phone: | 3603185636 |
| Fax: |