Healthcare Provider Details

I. General information

NPI: 1508303793
Provider Name (Legal Business Name): RENTON HEALTHCARE REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SW 2ND ST
RENTON WA
98057-5937
US

IV. Provider business mailing address

230 N MARYLAND AVE STE 300
GLENDALE CA
91206-4281
US

V. Phone/Fax

Practice location:
  • Phone: 425-226-4610
  • Fax:
Mailing address:
  • Phone: 323-936-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1554
License Number StateWA

VIII. Authorized Official

Name: SAMUEL ZACK
Title or Position: MEMBER
Credential:
Phone: 323-936-6000