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NPI Code Detail

MEDICARE: UNIVERSITY PLACE CARE CENTER

MEDICARE: UNIVERSITY PLACE CARE CENTER
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
1314000000XSkilled Nursing FacilityNH 1098WA

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 : 1649275140
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY PLACE CARE CENTER
Provider Business Mailing Address
First Line : 5520 BRIDGEPORT WAY W
Second Line :
City : UNIVERSITY PLACE
State : WA
Zip : 98467-2041
Country : US
Telephone Number : 253-566-7166
Fax Number : 253-564-8034
Provider Business Practice Location Address
First Line : 5520 BRIDGEPORT WAY W
Second Line :
City : UNIVERSITY PLACE
State : WA
Zip : 98467-2041
Country : US
Telephone Number : 253-566-7166
Fax Number : 253-564-8034
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : MS. NOLA A DAVIS-MILLER
Credential :
Telephone Number : 253-566-7166
Provider Enumeration Date : 06/20/2005
Last Update Date : 07/21/2008

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Directions to “UNIVERSITY PLACE CARE CENTER ” Practice Location

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