Healthcare Provider Details

I. General information

NPI: 1457152514
Provider Name (Legal Business Name): WAILEA BEACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W HEMLOCK ST
SEQUIM WA
98382-3718
US

IV. Provider business mailing address

599 MENLO DR STE 200
ROCKLIN CA
95765-3725
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RYAN WILLIAMS
Title or Position: MANAGER
Credential:
Phone: 916-945-1248