Healthcare Provider Details

I. General information

NPI: 1730518531
Provider Name (Legal Business Name): EXTENDICARE NORTH AUBURN REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 I ST NE
AUBURN WA
98002-2410
US

IV. Provider business mailing address

2830 I ST NE
AUBURN WA
98002-2410
US

V. Phone/Fax

Practice location:
  • Phone: 253-561-8100
  • Fax: 253-333-1718
Mailing address:
  • Phone: 253-561-8100
  • Fax: 253-333-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberOC60282758
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOC60282758
License Number StateWA

VIII. Authorized Official

Name: MRS. TENISHA CHESNEY
Title or Position: CERTIFIED OCCUPATIONAL THERAPY ASST
Credential:
Phone: 206-229-7418