Healthcare Provider Details

I. General information

NPI: 1043257421
Provider Name (Legal Business Name): BD MONROE I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 W MAIN ST
MONROE WA
98272-2022
US

IV. Provider business mailing address

3326 160TH AVE SE
BELLEVUE WA
98008-6418
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-4011
  • Fax: 360-805-1724
Mailing address:
  • Phone: 425-392-4066
  • Fax: 425-623-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1135
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1135
License Number StateWA

VIII. Authorized Official

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