MEDICARE: MIRABELLA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1501	OTHER	WA	NURSING HOME LICENSE

General Provider Information

NPI Number	:	1679722805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRABELLA

Provider Business Mailing Address
First Line	:	116 FAIRVIEW AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-5360
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 FAIRVIEW AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-5360
Country	:	US
Telephone Number	:	206-254-1400
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KY MOODY
Credential	:
Telephone Number	:	206-291-6103

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	12/11/2025

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Directions to “MIRABELLA ” Practice Location

Language	Start Address	Practice Location

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