Healthcare Provider Details

I. General information

NPI: 1720087448
Provider Name (Legal Business Name): BELMONT TERRACE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 LEBO BLVD
BREMERTON WA
98310-2617
US

IV. Provider business mailing address

560 LEBO BLVD
BREMERTON WA
98310-2617
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH575
License Number StateWA

VIII. Authorized Official

Name: MR. ROBERT M WASHBOND
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 360-479-1515