Provider Demographics
NPI:1508877895
Name:WAATU INC.
Entity Type:Organization
Organization Name:WAATU INC.
Other - Org Name:FIDALGO CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-293-7222
Mailing Address - Street 1:911 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2513
Mailing Address - Country:US
Mailing Address - Phone:360-293-7222
Mailing Address - Fax:360-293-7281
Practice Address - Street 1:1105 27TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2710
Practice Address - Country:US
Practice Address - Phone:360-293-3174
Practice Address - Fax:360-293-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4113718314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4113718Medicaid
WA505216Medicare Oscar/Certification