=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710028303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKWAY NORTH CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 05/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12015 115TH AVE NE BLDG E SUITE 195
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-6940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-285-3883
-----------------------------------------------------
Fax | 425-285-3887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 N PARKWAY AVE
-----------------------------------------------------
City | BATTLE GROUND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98604-8004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-285-3883
-----------------------------------------------------
Fax | 425-285-3887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. LESLIE THIEME
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-285-3883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 1406
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------