Healthcare Provider Details

I. General information

NPI: 1114637022
Provider Name (Legal Business Name): PULLMAN NURSING & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 NW DEANE ST
PULLMAN WA
99163-3705
US

IV. Provider business mailing address

3220 ROSEDALE ST STE 200
GIG HARBOR WA
98335-1837
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-1566
  • Fax:
Mailing address:
  • Phone: 253-251-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RAPHAEL OSCHEROWITZ
Title or Position: MANAGER
Credential:
Phone: 253-251-9300