Provider Demographics
NPI:1457840795
Name:MISSION HEALTHCARE AT RENTON, LLC
Entity Type:Organization
Organization Name:MISSION HEALTHCARE AT RENTON, LLC
Other - Org Name:MISSION HEALTHCARE AT RENTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-853-4457
Mailing Address - Street 1:17420 106TH PL SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5438
Mailing Address - Country:US
Mailing Address - Phone:425-897-8800
Mailing Address - Fax:425-897-8801
Practice Address - Street 1:17420 106TH PL SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5438
Practice Address - Country:US
Practice Address - Phone:425-897-8800
Practice Address - Fax:425-897-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility