Provider Demographics
NPI:1306834627
Name:PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST
Entity Type:Organization
Organization Name:PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST
Other - Org Name:SKYLINE AT FIRST HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLEGREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-826-2126
Mailing Address - Street 1:715 9TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2066
Mailing Address - Country:US
Mailing Address - Phone:206-826-2120
Mailing Address - Fax:206-826-2110
Practice Address - Street 1:715 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2066
Practice Address - Country:US
Practice Address - Phone:206-826-2120
Practice Address - Fax:206-826-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABH213310400000X
WANH602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4160206Medicaid
WA4160206Medicaid