Healthcare Provider Details

I. General information

NPI: 1205820669
Provider Name (Legal Business Name): DELTA REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 TERRACE AVE
SNOHOMISH WA
98290-1914
US

IV. Provider business mailing address

1705 TERRACE AVE
SNOHOMISH WA
98290-1914
US

V. Phone/Fax

Practice location:
  • Phone: 360-568-2168
  • Fax: 360-568-5547
Mailing address:
  • Phone: 360-568-2168
  • Fax: 360-568-5547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. WALLACE J WALSH
Title or Position: ADMINISTRATOR
Credential:
Phone: 360-568-2168