1215966312 NPI number — REGENCY WENATCHEE LLC

Table of content: (NPI 1215966312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215966312 NPI number — REGENCY WENATCHEE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENCY WENATCHEE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REGENCY WENATCHEE REHABILIATION AND NURSING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215966312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3326 160TH AVE SE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98008-6418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-392-4066
Provider Business Mailing Address Fax Number:
425-623-1517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1326 RED APPLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801-3227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-682-2551
Provider Business Practice Location Address Fax Number:
509-682-4455
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEDDOE
Authorized Official First Name:
MARVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
425-392-4066

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1539 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4115391 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4114278 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0174692 . This is a "L & I NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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