Healthcare Provider Details

I. General information

NPI: 1285619577
Provider Name (Legal Business Name): NORTHWEST CARE-SHORELINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 NE 145TH ST
SHORELINE WA
98155-7134
US

IV. Provider business mailing address

25910 ACERO STE 350
MISSION VIEJO CA
92691-7908
US

V. Phone/Fax

Practice location:
  • Phone: 206-363-5856
  • Fax:
Mailing address:
  • Phone: 949-441-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1351
License Number StateWA

VIII. Authorized Official

Name: MARC JOHNSON
Title or Position: CHIEF FIANCIAL OFFICER
Credential:
Phone: 949-373-8373