1295919181 NPI number — NORTHLAKE REHABILITATION, LLC

Table of content: SARAH ELIZABETH FILLINGIM MD (NPI 1740975861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295919181 NPI number — NORTHLAKE REHABILITATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHLAKE REHABILITATION, 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:
Provider Other Organization Name Type Code:
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:
1295919181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18323 BOTHELL EVERETT HWY STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98012-5246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-806-5700
Provider Business Mailing Address Fax Number:
425-806-5701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18600 WOODINVILLE SNOHOMISH RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODINVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98072-8531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-488-6640
Provider Business Practice Location Address Fax Number:
425-488-5424
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
URBAN
Authorized Official First Name:
TARA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
425-806-5721

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7110141 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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