Provider Demographics
NPI:1174648604
Name:STATE OF WASHINGTON WASHINGTON SOLDIERS HOME
Entity Type:Organization
Organization Name:STATE OF WASHINGTON WASHINGTON SOLDIERS HOME
Other - Org Name:WA SOLDIERS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-725-2512
Mailing Address - Street 1:1301 ORTING KAPOWSIN HWY E
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360
Mailing Address - Country:US
Mailing Address - Phone:360-893-4506
Mailing Address - Fax:360-893-4590
Practice Address - Street 1:1301 ORTING-KAPOWSIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360
Practice Address - Country:US
Practice Address - Phone:360-725-4506
Practice Address - Fax:360-893-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA400014Medicaid
WA4924785OtherNCPDP
WA7130479Medicaid
G001056401Medicare PIN
WA7130479Medicaid