1952921124 NPI number — EMPRES AT SEATTLE, LLC

Table of content: (NPI 1952921124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952921124 NPI number — EMPRES AT SEATTLE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPRES AT SEATTLE, 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:
TRANSITIONAL CARE CENTER OF SEATTLE
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:
1952921124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 NE 77TH AVE # SUIE300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98662-6729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-892-6628
Provider Business Mailing Address Fax Number:
360-882-5789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2611 S DEARBORN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-892-6628
Provider Business Practice Location Address Fax Number:
360-882-5793
Provider Enumeration Date:
04/17/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CEO AND ASSISTANT MANAGER
Authorized Official Telephone Number:
360-892-6628

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 505534 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2155326 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 604595856 . This is a "SECRETARY OF STATE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1621 . This is a "DSHS NH LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 50D2192671 . This is a "CLIA WAIVER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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