Provider Demographics
NPI:1326033986
Name:OPPORTUNITIES INDUSTRIALIZATION CENTER OF WASHINGTON
Entity Type:Organization
Organization Name:OPPORTUNITIES INDUSTRIALIZATION CENTER OF WASHINGTON
Other - Org Name:LEON SULLIVAN HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-325-6700
Mailing Address - Street 1:2611 S DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3013
Mailing Address - Country:US
Mailing Address - Phone:206-325-6700
Mailing Address - Fax:206-325-4088
Practice Address - Street 1:2611 S DEARBORN ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-3013
Practice Address - Country:US
Practice Address - Phone:206-325-6700
Practice Address - Fax:206-325-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600514067314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4113403Medicaid
WA505511Medicare Oscar/Certification