MEDICARE: ROCKY BAY HEALTH CARE FACILITY

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	NH822	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	:	1346459138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY BAY HEALTH CARE FACILITY

Provider Business Mailing Address
First Line	:	17526 STATE ROUTE 302 KP N
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-5672
Country	:	US
Telephone Number	:	253-884-2277
Fax Number	:	253-884-3328

Provider Business Practice Location Address
First Line	:	17526 STATE ROUTE 302 KP N
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-5672
Country	:	US
Telephone Number	:	253-884-2277
Fax Number	:	253-884-3328

Authorized Official
Title or Position	:	OWNER ADMINISTRATOR
Name	:	MRS. EDITH M MOORE
Credential	:	RN ADMINISTRATOR
Telephone Number	:	253-884-2277

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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