Healthcare Provider Details

I. General information

NPI: 1366154791
Provider Name (Legal Business Name): SHORELINE OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 NE 145TH ST
SHORELINE WA
98155-7134
US

IV. Provider business mailing address

25115 SW PARKWAY AVE STE B
WILSONVILLE OR
97070-8891
US

V. Phone/Fax

Practice location:
  • Phone: 206-363-5856
  • Fax:
Mailing address:
  • Phone: 503-830-8451
  • 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: MARY E. KOFSTAD
Title or Position: CEO
Credential:
Phone: 971-224-2033