Provider Demographics
NPI:1508864935
Name:REGENCY COUPEVILLE, LLC
Entity Type:Organization
Organization Name:REGENCY COUPEVILLE, LLC
Other - Org Name:REGENCY COUPEVILLE REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-623-1466
Mailing Address - Street 1:311 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-3427
Mailing Address - Country:US
Mailing Address - Phone:360-678-2273
Mailing Address - Fax:360-678-0510
Practice Address - Street 1:311 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3427
Practice Address - Country:US
Practice Address - Phone:360-678-2273
Practice Address - Fax:360-678-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-10
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604622050OtherUBI NUMBER
WA601301516Medicare UPIN
WA505309Medicare ID - Type UnspecifiedFEDERAL PROVIDER NUMBER