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General NPI Number Information
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NPI Number | 1649654617
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Entity Type | Organization
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Legal Business Name | 4755 SOUTH 48TH STREET OPERATIONS LLC
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Dates
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Enumeration Date | 07/19/2015
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 4755 S 48TH ST
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City | TACOMA
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State | WA
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Zip | 98409-1919
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Country | US
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Telephone | 253-475-6600
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Fax | 253-475-6611
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Provider Business Mailing Address
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Address Line | 4755 S 48TH ST
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City | TACOMA
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State | WA
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Zip | 98409-1919
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Country | US
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Telephone | 253-475-6600
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Fax | 253-475-6611
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Authorized Official
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Title or Position | OFFICER
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Name | AVROHOM TRESS
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Credential |
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Telephone | 760-445-0699
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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 | 1531
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License Number State | WA
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