MEDICARE: EAST WENATCHEE VENTURES, L.L.C.

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1528685435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST WENATCHEE VENTURES, L.L.C.

Provider Business Mailing Address
First Line	:	7700 NE PARKWAY DR STE 300
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	589 HIGHLINE DR
Second Line	:
City	:	EAST WENATCHEE
State	:	WA
Zip	:	98802-5495
Country	:	US
Telephone Number	:	509-884-3938
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	GREGORY VISLOCKY
Credential	:
Telephone Number	:	360-735-7155

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	06/26/2020

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