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General NPI Number Information
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NPI Number | 1326273889
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Entity Type | Organization
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Legal Business Name | PINEHURST PARK ROYAL OPERATIONS, LLC
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 2818 NE 145TH ST
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City | SHORELINE
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State | WA
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Zip | 98155-7556
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Country | US
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Telephone | 206-418-2900
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Fax | 206-365-3295
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Provider Business Mailing Address
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Address Line | 50 116TH AVE SE SUITE 200
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City | BELLEVUE
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State | WA
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Zip | 98004-6436
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Country | US
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Telephone | 425-451-4700
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Fax | 425-453-6869
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. MARC HARRY PRYDE
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Credential |
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Telephone | 425-451-4700
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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 |
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License Number State |
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