MEDICARE: CASCADES AT THORNTON CREEK 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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1366275067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASCADES AT THORNTON CREEK LLC

Provider Business Mailing Address
First Line	:	3540 NE 110TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5761
Country	:	US
Telephone Number	:	206-363-7733
Fax Number	:	206-363-1876

Provider Business Practice Location Address
First Line	:	3540 NE 110TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5761
Country	:	US
Telephone Number	:	206-363-7733
Fax Number	:	206-363-1876

Authorized Official
Title or Position	:	CEO
Name	:	DARIN MCSPADDEN
Credential	:
Telephone Number	:	801-426-4905

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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