Healthcare Provider Details

I. General information

NPI: 1710218656
Provider Name (Legal Business Name): RICHMOND BEACH REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19235 15TH AVE NW
SHORELINE WA
98177-2725
US

IV. Provider business mailing address

10014 5TH AVE NE #302
SEATTLE WA
98125-7447
US

V. Phone/Fax

Practice location:
  • Phone: 206-546-2666
  • Fax:
Mailing address:
  • Phone: 520-591-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSI 60112795
License Number StateWA

VIII. Authorized Official

Name: KELSEY J ADAMS
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MS
Phone: 520-591-2919