Provider Demographics
NPI:1053306118
Name:WEST VALLEY NURSING HOMES LIVING CARE CENTERS INC
Entity Type:Organization
Organization Name:WEST VALLEY NURSING HOMES LIVING CARE CENTERS INC
Other - Org Name:SUMMITVIEW HEALTHCARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MALGESINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-965-5245
Mailing Address - Street 1:3801 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2794
Mailing Address - Country:US
Mailing Address - Phone:509-966-6240
Mailing Address - Fax:509-965-5251
Practice Address - Street 1:3801 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2794
Practice Address - Country:US
Practice Address - Phone:509-966-6240
Practice Address - Fax:509-965-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH 359314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4135901Medicaid
WA505409Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER