Provider Demographics
NPI:1518355569
Name:EAST ADAMS CARE CENTER LLC
Entity Type:Organization
Organization Name:EAST ADAMS CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-659-5402
Mailing Address - Street 1:903 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169-2227
Mailing Address - Country:US
Mailing Address - Phone:509-659-1200
Mailing Address - Fax:509-659-1252
Practice Address - Street 1:506 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-2106
Practice Address - Country:US
Practice Address - Phone:509-659-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603-462-445314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility