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General NPI Number Information
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NPI Number | 1558360024
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Entity Type | Organization
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Legal Business Name | MANOR PARK HEALTHCARE LLC
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 1710 PLAZA WAY
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City | WALLA WALLA
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State | WA
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Zip | 99362-4362
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Country | US
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Telephone | 509-529-4218
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Fax | 509-522-1729
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Provider Business Mailing Address
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Address Line | 1710 PLAZA WAY
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City | WALLA WALLA
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State | WA
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Zip | 99362-4362
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Country | US
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Telephone | 509-529-4218
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Fax | 509-522-1729
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Authorized Official
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Title or Position | TREASURER
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Name | SOON BURNAM
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Credential |
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Telephone | 949-540-1249
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1342
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License Number State | WA
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