Healthcare Provider Details

I. General information

NPI: 1568429900
Provider Name (Legal Business Name): BROADVIEW DEVELOPMENT ASSOCIATES II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 GREENWOOD AVE N
SEATTLE WA
98133
US

IV. Provider business mailing address

12505 GREENWOOD AVE N
SEATTLE WA
98133
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-3797
  • Fax: 206-368-3756
Mailing address:
  • Phone: 206-368-3797
  • Fax: 206-368-3756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number945
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1065
License Number StateWA

VIII. Authorized Official

Name: TARA L TRAVERS
Title or Position: DIRECTOR OF CLINICAL SERVICES ADMIN
Credential: NHA
Phone: 206-368-3797