Provider Demographics
NPI:1225547912
Name:WESLEY HOMES LEA HILL LLC
Entity Type:Organization
Organization Name:WESLEY HOMES LEA HILL LLC
Other - Org Name:LEA HILL REHABILITATION AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-870-1223
Mailing Address - Street 1:815 S 216TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6332
Mailing Address - Country:US
Mailing Address - Phone:206-870-1260
Mailing Address - Fax:
Practice Address - Street 1:32049 109TH PL SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-2567
Practice Address - Country:US
Practice Address - Phone:253-876-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1551314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4115511Medicaid