1720207186 NPI number — BD REDMOND IV LLC

Table of content: (NPI 1720207186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720207186 NPI number — BD REDMOND IV LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BD REDMOND IV 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 REDMOND REHABILITATION 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:
1720207186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2016
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:
3025 SW RESERVOIR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97756-9481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-548-5066
Provider Business Practice Location Address Fax Number:
541-548-3752
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEVORE
Authorized Official First Name:
DOUG
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
425-392-4066

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1560569881 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500620747 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800083 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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