=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144594086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST COUNTY OPERATIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2012
-----------------------------------------------------
Last Update Date | 02/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 SE 177TH AVE
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98683-4201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-944-6000
-----------------------------------------------------
Fax | 360-514-5459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 SE 177TH AVE
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98683-4201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-944-6000
-----------------------------------------------------
Fax | 360-514-5459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. ERIC CHRISTENSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-944-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 1991
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------