Healthcare Provider Details

I. General information

NPI: 1386639433
Provider Name (Legal Business Name): HIGHLINE CARE CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 HIGHLINE DR
EAST WENATCHEE WA
98802-5603
US

IV. Provider business mailing address

625 OKANOGAN AVE
WENATCHEE WA
98801-6409
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-1636
  • Fax: 509-662-8690
Mailing address:
  • Phone: 509-662-1636
  • Fax: 509-662-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1306
License Number StateWA

VIII. Authorized Official

Name: MS. DIANA V WILEY
Title or Position: CONTROLLER
Credential:
Phone: 509-662-1636