Provider Demographics
NPI:1568429900
Name:BROADVIEW DEVELOPMENT ASSOCIATES II
Entity Type:Organization
Organization Name:BROADVIEW DEVELOPMENT ASSOCIATES II
Other - Org Name:IDA CULVER HOUSE BROADVIEW HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:206-368-3797
Mailing Address - Street 1:12505 GREENWOOD AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:206-368-3797
Mailing Address - Fax:206-368-3756
Practice Address - Street 1:12505 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-368-3797
Practice Address - Fax:206-368-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA945310400000X
WA1065314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CU2614OtherREGENCE BLUE SHIELD
WA4110656Medicaid
WA505377Medicare Oscar/Certification