MEDICARE: MBB KENNEWICK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NH1241	WA
2	314000000X	Skilled Nursing Facility	1537	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144210162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBB KENNEWICK LLC

Provider Business Mailing Address
First Line	:	3326 160TH AVE SE
Second Line	:	SUITE 120
City	:	BELLEVUE
State	:	WA
Zip	:	98008-6418
Country	:	US
Telephone Number	:	425-392-4066
Fax Number	:	425-623-1517

Provider Business Practice Location Address
First Line	:	2702 S ELY ST
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99337-3014
Country	:	US
Telephone Number	:	509-582-5900
Fax Number	:	509-582-4944

Authorized Official
Title or Position	:	CEO
Name	:	MR. MARVIN B BEDDOE
Credential	:
Telephone Number	:	425-392-4066

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	06/29/2016

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