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General NPI Number Information
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NPI Number | 1215157623
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Entity Type | Organization
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Legal Business Name | KELSEY PARK A.F.H.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12649 SE 4TH PL
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City | BELLEVUE
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State | WA
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Zip | 98005-3507
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Country | US
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Telephone | 425-453-0173
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Fax | 425-453-0969
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Provider Business Mailing Address
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Address Line | 12649 S.E 4TH PLACE
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City | BELLEVUE
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State | WA
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Zip | 98005-3507
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Country | US
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Telephone | 425-453-0173
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Fax | 425-453-0969
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MS. LUCY MURESAN
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Credential | ASSISTANT NURSE
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Telephone | 425-453-0173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 36100
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License Number State | WA
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