Healthcare Provider Details

I. General information

NPI: 1306834627
Provider Name (Legal Business Name): PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 9TH AVE
SEATTLE WA
98104-2066
US

IV. Provider business mailing address

715 9TH AVE SUITE 400
SEATTLE WA
98104-2066
US

V. Phone/Fax

Practice location:
  • Phone: 206-826-2120
  • Fax: 206-826-2110
Mailing address:
  • Phone: 206-826-2120
  • Fax: 206-826-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberBH213
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH602
License Number StateWA

VIII. Authorized Official

Name: MR. FREDERICK M KELLEGREW
Title or Position: PRESIDENT & CEO
Credential:
Phone: 206-826-2126