Healthcare Provider Details

I. General information

NPI: 1376538637
Provider Name (Legal Business Name): SPOKANE ROYAL PARK CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 NORTH NEVADA STREET
SPOKANE WA
99208-5518
US

IV. Provider business mailing address

4601 NE 77TH AVENUE SUITE 300
VANCOUVER WA
98662-6736
US

V. Phone/Fax

Practice location:
  • Phone: 509-489-2273
  • Fax: 509-482-3041
Mailing address:
  • Phone: 360-892-6628
  • Fax: 360-882-5793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1327
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1471
License Number StateWA

VIII. Authorized Official

Name: BRENT WEIL
Title or Position: CEO AND MANAGER
Credential:
Phone: 360-892-6628