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1538159702

NPI Code Detail

MEDICARE: STATE OF WASHINGTON, WASHINGTON VETERANS HOMES

MEDICARE: STATE OF WASHINGTON, WASHINGTON VETERANS HOMES

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	310400000X	Assisted Living Facility		WA
2	313M00000X	Nursing Facility/Intermediate Care Facility	N/A	WA
3	310400000X	Assisted Living Facility	N/A	WA
4	313M00000X	Nursing Facility/Intermediate Care Facility		WA
5	314000000X	Skilled Nursing Facility	NOT APPLICABLE	WA
6	314000000X	Skilled Nursing Facility		WA
7	314000000X	Skilled Nursing Facility

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50-5517	OTHER		MEDICARE A

Other Identifiers

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

General Provider Information

NPI Number	:	1538159702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF WASHINGTON, WASHINGTON VETERANS HOMES

Provider Business Mailing Address
First Line	:	1141 BEACH DR E
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-4937
Country	:	US
Telephone Number	:	360-895-4700
Fax Number	:	360-895-4453

Provider Business Practice Location Address
First Line	:	1141 BEACH DR E
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-4937
Country	:	US
Telephone Number	:	360-895-4700
Fax Number	:	360-895-4453

Authorized Official
Title or Position	:	CFO
Name	:	MR. TERRANCE WESTHOFF
Credential	:
Telephone Number	:	360-725-2152

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	10/23/2023

Similar Medicare Providers

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Practice Location Address:

1141 BEACH DR E
PORT ORCHARD, WA
98366-4937

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1376587899 — GERARD V LASALLE MD
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1619983939 — BOBBI KAY PHILIPS DI
Practice Location Address:

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1205947322 — EMI M STOREY PT
Practice Location Address:

1141 BEACH DR E
PORT ORCHARD, WA
98366-4937

Practice Phone: 360-895-4700
Practice Fax:

1770694283 — ELIZABETH ANN BRODIE-KNOPE PT
Practice Location Address:

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Practice Fax:

1528116068 — MS. BRIANNA MARIE CHANDLER RD
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Directions to “STATE OF WASHINGTON, WASHINGTON VETERANS HOMES ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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