Provider Demographics
NPI:1326391582
Name:VIDELL HEALTHCARE MERCER ISLAND, L.L.C.
Entity Type:Organization
Organization Name:VIDELL HEALTHCARE MERCER ISLAND, L.L.C.
Other - Org Name:MERCER ISLAND CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAFORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-277-3197
Mailing Address - Street 1:16400 SOUTHCENTER PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3383
Mailing Address - Country:US
Mailing Address - Phone:253-277-3197
Mailing Address - Fax:
Practice Address - Street 1:7445 SE 24TH ST
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2326
Practice Address - Country:US
Practice Address - Phone:253-277-3197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIDELL HEALTHCARE, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-24
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility