Provider Demographics
NPI:1326273889
Name:PINEHURST PARK ROYAL OPERATIONS, LLC
Entity Type:Organization
Organization Name:PINEHURST PARK ROYAL OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:PRYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-451-4700
Mailing Address - Street 1:50 116TH AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6436
Mailing Address - Country:US
Mailing Address - Phone:425-451-4700
Mailing Address - Fax:425-453-6869
Practice Address - Street 1:2818 NE 145TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7556
Practice Address - Country:US
Practice Address - Phone:206-418-2900
Practice Address - Fax:206-365-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4114211Medicaid
WA505262Medicare Oscar/Certification