Healthcare Provider Details

I. General information

NPI: 1952940827
Provider Name (Legal Business Name): WCC OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2019
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 S WALDEN ST
SEATTLE WA
98144-6830
US

IV. Provider business mailing address

456 CHESTNUT ST UNIT 303
LAKEWOOD NJ
08701-6124
US

V. Phone/Fax

Practice location:
  • Phone: 206-725-2800
  • Fax:
Mailing address:
  • Phone: 347-693-4239
  • Fax:

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: YITZCHOK YENOWITZ
Title or Position: MANAGER
Credential:
Phone: 347-693-4239