Healthcare Provider Details

I. General information

NPI: 1194763565
Provider Name (Legal Business Name): SHARON CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 HARRISON AVE
CENTRALIA WA
98531-4568
US

IV. Provider business mailing address

1509 HARRISON AVE
CENTRALIA WA
98531-4568
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-0112
  • Fax: 360-807-0667
Mailing address:
  • Phone: 360-736-0112
  • Fax: 360-807-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1304
License Number StateWA

VIII. Authorized Official

Name: DOUG DEVORE
Title or Position: CFO
Credential:
Phone: 425-392-4066