Healthcare Provider Details

I. General information

NPI: 1174097224
Provider Name (Legal Business Name): BFG OLYMPIA PROPCO III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 FIELDSTONE DR SW
OLYMPIA WA
98502-5500
US

IV. Provider business mailing address

506 N 40TH AVE STE 100
YAKIMA WA
98908-4330
US

V. Phone/Fax

Practice location:
  • Phone: 360-250-9229
  • Fax:
Mailing address:
  • Phone: 509-426-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: FAYE GORDON
Title or Position: MANAGER DIRECTOR OF COMPLIANCE
Credential: DO
Phone: 509-426-2756