Provider Demographics
NPI:1073139119
Name:CHEHALIS WEST ASSISTED LIVING CENTER INC
Entity Type:Organization
Organization Name:CHEHALIS WEST ASSISTED LIVING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-748-9911
Mailing Address - Street 1:478 NW QUINCY PL
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-1628
Mailing Address - Country:US
Mailing Address - Phone:360-748-9911
Mailing Address - Fax:360-748-4642
Practice Address - Street 1:478 NW QUINCY PL
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-1628
Practice Address - Country:US
Practice Address - Phone:360-748-9911
Practice Address - Fax:360-748-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA111783901Medicaid