Healthcare Provider Details

I. General information

NPI: 1962496745
Provider Name (Legal Business Name): NORTH CENTRAL CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 N WALL STREET
SPOKANE WA
99205-4606
US

IV. Provider business mailing address

1812 N WALL STREET
SPOKANE WA
99205-4606
US

V. Phone/Fax

Practice location:
  • Phone: 509-328-6030
  • Fax: 509-327-7026
Mailing address:
  • Phone: 509-328-6030
  • Fax: 509-327-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1144
License Number StateWA

VIII. Authorized Official

Name: DEAN MYERS
Title or Position: VP OF CLINICAL SERVICES
Credential:
Phone: 509-328-6030