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General NPI Number Information
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NPI Number | 1245227131
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Entity Type | Organization
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Legal Business Name | NORTHWEST COUNTRY PLACE, INC
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 917 S SCHEUBER RD
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City | CENTRALIA
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State | WA
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Zip | 98531-9027
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Country | US
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Telephone | 360-736-9384
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Fax | 360-736-6284
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Provider Business Mailing Address
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Address Line | 917 S SCHEUBER RD
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City | CENTRALIA
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State | WA
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Zip | 98531-9027
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Country | US
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Telephone | 360-736-9384
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Fax | 360-736-6284
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. TERRY L. LENO
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Credential |
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Telephone | 360-736-9384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH1138
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License Number State | WA
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