| NPI | 1396101580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID W AGNOR Executive Director 360-253-4912 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: WA PY 60550073) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: AK 558) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2016-01-05 |