Healthcare Provider Details

I. General information

NPI: 1356383202
Provider Name (Legal Business Name): BD COLLEGE PLACE I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SE MYRA RD
COLLEGE PLACE WA
99324-1796
US

IV. Provider business mailing address

3326 160TH AVE SE SUITE 120
BELLEVUE WA
98008-6418
US

V. Phone/Fax

Practice location:
  • Phone: 509-529-4480
  • Fax: 509-529-8776
Mailing address:
  • Phone: 425-392-4066
  • Fax: 425-623-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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