Healthcare Provider Details

I. General information

NPI: 1669419271
Provider Name (Legal Business Name): BD SPOKANE I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E WESTVIEW CT
SPOKANE WA
99218-3813
US

IV. Provider business mailing address

3326 160TH AVE SE SUITE 120
BELLEVUE WA
98008-6418
US

V. Phone/Fax

Practice location:
  • Phone: 509-465-8800
  • Fax: 509-444-2330
Mailing address:
  • Phone: 425-392-4066
  • Fax: 425-623-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1432
License Number StateWA

VIII. Authorized Official

Name: DOUG DEVORE
Title or Position: CFO
Credential:
Phone: 425-392-4066