Provider Demographics
NPI:1407271430
Name:WILDWOOD HEALTHCARE, INC.
Entity Type:Organization
Organization Name:WILDWOOD HEALTHCARE, INC.
Other - Org Name:RAINIER REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:920 12TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4920
Mailing Address - Country:US
Mailing Address - Phone:253-841-3422
Mailing Address - Fax:253-848-3937
Practice Address - Street 1:920 12TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4920
Practice Address - Country:US
Practice Address - Phone:253-841-3422
Practice Address - Fax:253-848-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA505304Medicare Oscar/Certification