Provider Demographics
NPI:1275938243
Name:WEEPING RIDGE WEST, INC.
Entity Type:Organization
Organization Name:WEEPING RIDGE WEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-989-1843
Mailing Address - Street 1:12402 OSPREY RD
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026
Mailing Address - Country:US
Mailing Address - Phone:509-989-1843
Mailing Address - Fax:509-465-1813
Practice Address - Street 1:2455 WEST BENCH RD
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344
Practice Address - Country:US
Practice Address - Phone:509-989-1843
Practice Address - Fax:509-465-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA751171311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA273641OtherADULT FAMILY HOME