Healthcare Provider Details

I. General information

NPI: 1528059094
Provider Name (Legal Business Name): BAYVIEW MANOR HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 W ALOHA ST
SEATTLE WA
98119-3743
US

IV. Provider business mailing address

11 W ALOHA ST
SEATTLE WA
98119-3743
US

V. Phone/Fax

Practice location:
  • Phone: 206-284-7330
  • Fax: 206-284-9640
Mailing address:
  • Phone: 206-284-7330
  • Fax: 206-284-9640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH461
License Number StateWA

VIII. Authorized Official

Name: RICHARD D TOMLINSON
Title or Position: CEO
Credential:
Phone: 206-284-7330