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NPI Code Detail

MEDICARE: PORT ORCHARD OPERATIONS, LLC

MEDICARE: PORT ORCHARD OPERATIONS, 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1750534939
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORT ORCHARD OPERATIONS, LLC
Provider Business Mailing Address
First Line : 3001 KEITH ST NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-3713
Country : US
Telephone Number : 423-473-5751
Fax Number : 423-339-8342
Provider Business Practice Location Address
First Line : 2031 POTTERY AVE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-2010
Country : US
Telephone Number : 360-876-8035
Fax Number : 360-895-0975
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : CINDY S CROSS
Credential :
Telephone Number : 423-473-5867
Provider Enumeration Date : 10/31/2008
Last Update Date : 10/31/2008

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Directions to “PORT ORCHARD OPERATIONS, LLC ” Practice Location

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