Healthcare Provider Details

I. General information

NPI: 1780759977
Provider Name (Legal Business Name): SEQUIM HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W HEMLOCK ST
SEQUIM WA
98382-3718
US

IV. Provider business mailing address

650 W HEMLOCK ST
SEQUIM WA
98382-3718
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-2400
  • Fax: 360-582-2419
Mailing address:
  • Phone: 360-582-2400
  • Fax: 360-582-2419

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:

# 1
Identifier4114120
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: MR. DOV E. JACOBS
Title or Position: MANAGER
Credential:
Phone: 323-678-4426