Provider Demographics
NPI:1487217824
Name:MISSION HEALTHCARE AT BELLEVUE, JOINT VENTURE
Entity Type:Organization
Organization Name:MISSION HEALTHCARE AT BELLEVUE, JOINT VENTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONDELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-362-6200
Mailing Address - Street 1:4411 POINT FOSDICK DR NW STE 203
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1703
Mailing Address - Country:US
Mailing Address - Phone:253-853-4457
Mailing Address - Fax:
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:425-362-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION HEALTHCARE AT BELLEVUE, JOINT VENTURE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility