Healthcare Provider Details

I. General information

NPI: 1225136385
Provider Name (Legal Business Name): BD NORTH BEND I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 CEDAR AVE S
NORTH BEND WA
98045-8262
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 425-888-2129
  • Fax: 425-888-2168
Mailing address:
  • Phone: 425-392-4066
  • Fax: 425-623-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1431
License Number StateWA

VIII. Authorized Official

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