Healthcare Provider Details

I. General information

NPI: 1952921124
Provider Name (Legal Business Name): EMPRES AT SEATTLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 S DEARBORN ST
SEATTLE WA
98144-3013
US

IV. Provider business mailing address

4601 NE 77TH AVE # SUIE300
VANCOUVER WA
98662-6729
US

V. Phone/Fax

Practice location:
  • Phone: 360-892-6628
  • Fax: 360-882-5793
Mailing address:
  • Phone: 360-892-6628
  • Fax: 360-882-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J. MILLER
Title or Position: CEO AND ASSISTANT MANAGER
Credential:
Phone: 360-892-6628