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1376538637

NPI Code Detail

MEDICARE: SPOKANE ROYAL PARK CARE, LLC

MEDICARE: SPOKANE ROYAL PARK CARE, 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	NH1327	WA
2	314000000X	Skilled Nursing Facility	NH1471	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	540	OTHER	WA	PREMERA BLUE CROSS
2	551673001	OTHER	WA	GROUP HEALTH (INSURANCE)
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376538637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPOKANE ROYAL PARK CARE, LLC

Provider Business Mailing Address
First Line	:	4601 NE 77TH AVENUE
Second Line	:	SUITE 300
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6736
Country	:	US
Telephone Number	:	360-892-6628
Fax Number	:	360-882-5793

Provider Business Practice Location Address
First Line	:	7411 NORTH NEVADA STREET
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-5518
Country	:	US
Telephone Number	:	509-489-2273
Fax Number	:	509-482-3041

Authorized Official
Title or Position	:	CEO AND MANAGER
Name	:	BRENT WEIL
Credential	:
Telephone Number	:	360-892-6628

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	01/30/2017

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Directions to “SPOKANE ROYAL PARK CARE, LLC ” Practice Location

Language	Start Address	Practice Location

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