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General NPI Number Information
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NPI Number | 1275938243
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Entity Type | Organization
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Legal Business Name | WEEPING RIDGE WEST, INC.
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 2455 WEST BENCH RD
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City | OTHELLO
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State | WA
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Zip | 99344
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Country | US
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Telephone | 509-989-1843
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Fax | 509-465-1813
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Provider Business Mailing Address
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Address Line | 12402 OSPREY RD
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City | NINE MILE FALLS
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State | WA
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Zip | 99026
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Country | US
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Telephone | 509-989-1843
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Fax | 509-465-1813
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ISRAEL RODRIGUEZ
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Credential |
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Telephone | 509-989-1843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 751171
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License Number State | WA
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