Provider Demographics
NPI:1568699197
Name:LSREF GOLDEN OPS 26 (WA), LLC
Entity Type:Organization
Organization Name:LSREF GOLDEN OPS 26 (WA), LLC
Other - Org Name:ORCHARD POINTE SENIOR ALZHEIMER COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-775-5857
Mailing Address - Street 1:500 STEVENS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 S KITSAP BLVD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3778
Practice Address - Country:US
Practice Address - Phone:360-874-7400
Practice Address - Fax:360-874-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA315196Medicaid