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NPI Code Detail

MEDICARE: BD MONROE I LLC

MEDICARE: BD MONROE I LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care Facility1135WA
2314000000XSkilled Nursing Facility1135WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043257421
Entity Type Code : Organization
Provider Name (Legal Business Name) : BD MONROE I LLC
Provider Business Mailing Address
First Line : 3326 160TH AVE SE
Second Line :
City : BELLEVUE
State : WA
Zip : 98008-6418
Country : US
Telephone Number : 425-392-4066
Fax Number : 425-623-1473
Provider Business Practice Location Address
First Line : 1355 W MAIN ST
Second Line :
City : MONROE
State : WA
Zip : 98272-2022
Country : US
Telephone Number : 360-794-4011
Fax Number : 360-805-1724
Authorized Official
Title or Position : CFO
Name : DOUG DEVORE
Credential :
Telephone Number : 425-392-4066
Provider Enumeration Date : 06/02/2006
Last Update Date : 05/15/2015

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Directions to “BD MONROE I LLC ” Practice Location

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