MEDICARE: BETHANY OF THE NORTHWEST

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	BH1346	WA

Other Identifiers

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

General Provider Information

NPI Number	:	1972715605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY OF THE NORTHWEST

Provider Business Mailing Address
First Line	:	PO BOX 5128
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98206
Country	:	US
Telephone Number	:	425-551-6343
Fax Number	:

Provider Business Practice Location Address
First Line	:	2131 LAKE HEIGHTS DRIVE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208
Country	:	US
Telephone Number	:	425-551-6343
Fax Number	:

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	MR. PRAD GUPTA
Credential	:
Telephone Number	:	425-551-6402

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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