Provider Demographics
NPI:1417038605
Name:LUTHERAN RETIREMENT HOME OF GREATER SEATTLE INC
Entity Type:Organization
Organization Name:LUTHERAN RETIREMENT HOME OF GREATER SEATTLE INC
Other - Org Name:THE HEARTHSTONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:R KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-517-2225
Mailing Address - Street 1:6720 E GREEN LAKE WAY N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5439
Mailing Address - Country:US
Mailing Address - Phone:206-517-2225
Mailing Address - Fax:206-517-2275
Practice Address - Street 1:6720 E GREEN LAKE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5439
Practice Address - Country:US
Practice Address - Phone:206-517-2225
Practice Address - Fax:206-517-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA505027314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4152708Medicaid
WA4152708Medicaid