Provider Demographics
NPI:1376538637
Name:SPOKANE ROYAL PARK CARE, LLC
Entity Type:Organization
Organization Name:SPOKANE ROYAL PARK CARE, LLC
Other - Org Name:ROYAL PARK HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-892-6628
Mailing Address - Street 1:4601 NE 77TH AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6736
Mailing Address - Country:US
Mailing Address - Phone:360-892-6628
Mailing Address - Fax:360-882-5793
Practice Address - Street 1:7411 NORTH NEVADA STREET
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5518
Practice Address - Country:US
Practice Address - Phone:509-489-2273
Practice Address - Fax:509-482-3041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPRES WASHINGTON HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-13
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH1327314000000X
WANH1471314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA540OtherPREMERA BLUE CROSS
WA551673001OtherGROUP HEALTH (INSURANCE)
WA4113270Medicaid
WA551673001OtherGROUP HEALTH (INSURANCE)
WA505379Medicare Oscar/Certification