Provider Demographics
NPI:1144210162
Name:MBB KENNEWICK LLC
Entity Type:Organization
Organization Name:MBB KENNEWICK LLC
Other - Org Name:REGENCY KENNEWICK REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BEDDOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-392-4066
Mailing Address - Street 1:3326 160TH AVE SE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-6418
Mailing Address - Country:US
Mailing Address - Phone:425-392-4066
Mailing Address - Fax:425-623-1517
Practice Address - Street 1:2702 S ELY ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-3014
Practice Address - Country:US
Practice Address - Phone:509-582-5900
Practice Address - Fax:509-582-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH1241314000000X
WA1537314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4115371Medicaid
WA4115371Medicaid