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General NPI Number Information
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NPI Number | 1437557436
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Entity Type | Organization
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Legal Business Name | WC-BREMERTON OPS, LLC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 2707 CLARE AVE
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City | BREMERTON
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State | WA
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Zip | 98310-3337
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Country | US
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Telephone | 360-377-1717
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Fax | 360-479-0527
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Provider Business Mailing Address
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Address Line | 2707 CLARE AVE
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City | BREMERTON
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State | WA
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Zip | 98310-3337
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Country | US
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Telephone | 360-377-1717
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Fax | 360-479-0527
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PEDER ALAN BERG
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Credential |
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Telephone | 360-377-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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