Provider Demographics
NPI:1386028397
Name:800 MEDCALF LANE NORTH OPERATIONS LLC
Entity Type:Organization
Organization Name:800 MEDCALF LANE NORTH OPERATIONS LLC
Other - Org Name:MONTESANO HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4742
Mailing Address - Street 1:800 N MEDCALF LN
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-1318
Mailing Address - Country:US
Mailing Address - Phone:360-249-2273
Mailing Address - Fax:360-249-2363
Practice Address - Street 1:800 N MEDCALF LN
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-1318
Practice Address - Country:US
Practice Address - Phone:360-249-2273
Practice Address - Fax:360-249-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility