Provider Demographics
NPI:1043582208
Name:WINDSOR GARDENS INC.
Entity Type:Organization
Organization Name:WINDSOR GARDENS INC.
Other - Org Name:WINDSOR GARDENS MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORI
Authorized Official - Middle Name:CORINA
Authorized Official - Last Name:HATEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:360-521-1300
Mailing Address - Street 1:1602 NE 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-9426
Mailing Address - Country:US
Mailing Address - Phone:360-521-1300
Mailing Address - Fax:360-260-3863
Practice Address - Street 1:1602 NE 162ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-9426
Practice Address - Country:US
Practice Address - Phone:360-521-1300
Practice Address - Fax:360-260-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAB2117310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility