Healthcare Provider Details

I. General information

NPI: 1205546579
Provider Name (Legal Business Name): OLYMPIC MARMOT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 LEBO BLVD
BREMERTON WA
98310-2617
US

IV. Provider business mailing address

29222 RANCHO VIEJO RD STE 127
SAN JUAN CAPISTRANO CA
92675-1049
US

V. Phone/Fax

Practice location:
  • Phone: 360-479-1515
  • Fax: 360-479-1699
Mailing address:
  • Phone: 949-487-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-487-9500