Healthcare Provider Details

I. General information

NPI: 1205811585
Provider Name (Legal Business Name): NORTHWEST CARE-WEST SEATTLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 CALIFORNIA AVE SW
SEATTLE WA
98116-1902
US

IV. Provider business mailing address

25910 ACERO STE 350
MISSION VIEJO CA
92691-7908
US

V. Phone/Fax

Practice location:
  • Phone: 206-937-9750
  • Fax:
Mailing address:
  • Phone: 949-441-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1352
License Number StateWA

VIII. Authorized Official

Name: MARC JOHNSON
Title or Position: CFO
Credential:
Phone: 949-373-8373