Provider Demographics
NPI:1164538062
Name:DUFFY I, LP
Entity Type:Organization
Organization Name:DUFFY I, LP
Other - Org Name:SCHICK SHADEL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:OKSENDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-244-8100
Mailing Address - Street 1:12101 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146
Mailing Address - Country:US
Mailing Address - Phone:206-244-8100
Mailing Address - Fax:206-431-9142
Practice Address - Street 1:12101 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-2651
Practice Address - Country:US
Practice Address - Phone:206-244-8100
Practice Address - Fax:206-431-9142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAH-002283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA170OtherPREMERA
WA500134Medicare ID - Type Unspecified