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NPI Code Detail

MEDICARE: STAFFORD HEALTHCARE, SEATAC, LLC

MEDICARE: STAFFORD HEALTHCARE, SEATAC, 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 Facility1364WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962493247
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAFFORD HEALTHCARE, SEATAC, LLC
Provider Business Mailing Address
First Line : 2800 SOUTH 224TH ST
Second Line :
City : DES MOINES
State : WA
Zip : 96198-5132
Country : US
Telephone Number : 206-824-0600
Fax Number : 206-824-5622
Provider Business Practice Location Address
First Line : 2800 SOUTH 224TH ST
Second Line :
City : DES MOINES
State : WA
Zip : 98198-5132
Country : US
Telephone Number : 206-824-0600
Fax Number : 206-824-5622
Authorized Official
Title or Position : VICE PRESIDENT OF OPERATIONS
Name : MR. JAMES KENNETH BENNETT JR.
Credential : MHA
Telephone Number : 206-824-0600
Provider Enumeration Date : 11/04/2005
Last Update Date : 12/08/2009

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Directions to “STAFFORD HEALTHCARE, SEATAC, LLC ” Practice Location

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