Healthcare Provider Details

I. General information

NPI: 1174648604
Provider Name (Legal Business Name): STATE OF WASHINGTON WASHINGTON SOLDIERS HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 ORTING-KAPOWSIN HIGHWAY
ORTING WA
98360
US

IV. Provider business mailing address

1301 ORTING KAPOWSIN HWY E
ORTING WA
98360
US

V. Phone/Fax

Practice location:
  • Phone: 360-725-4506
  • Fax: 360-893-4590
Mailing address:
  • Phone: 360-893-4506
  • Fax: 360-893-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHEAL KASHMAR
Title or Position: CFO
Credential:
Phone: 360-725-2512