Healthcare Provider Details

I. General information

NPI: 1841762382
Provider Name (Legal Business Name): WELLTOWER COGIR TENANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 15TH AVE NE
SEATTLE WA
98125-6320
US

IV. Provider business mailing address

14905 BOTHELL EVERETT HWY
MILL CREEK WA
98012-5315
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-7250
  • Fax:
Mailing address:
  • Phone: 418-209-6169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateNULL

VIII. Authorized Official

Name: BENOIT LEVESQUE
Title or Position: SENIOR REGIONAL DIRECTOR
Credential:
Phone: 418-209-6169