MEDICARE: BELLINGHAM SOUTH OF CASCADIA, 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

General Provider Information

NPI Number	:	1811656259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLINGHAM SOUTH OF CASCADIA, LLC

Provider Business Mailing Address
First Line	:	2205 E RIVERSIDE DR STE 100
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-7621
Country	:	US
Telephone Number	:	208-401-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 SAMISH WAY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-3346
Country	:	US
Telephone Number	:	208-401-9600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OWEN C HAMMOND
Credential	:
Telephone Number	:	208-401-9600

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	05/24/2024

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