Provider Demographics
NPI:1568780120
Name:QUALITY HEALTH CARE OF BOTHELL LLC
Entity Type:Organization
Organization Name:QUALITY HEALTH CARE OF BOTHELL LLC
Other - Org Name:BOTHELL HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BINGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-481-8500
Mailing Address - Street 1:707 228TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9733
Mailing Address - Country:US
Mailing Address - Phone:425-481-8500
Mailing Address - Fax:425-487-2804
Practice Address - Street 1:707 228TH ST SW
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9733
Practice Address - Country:US
Practice Address - Phone:425-481-8500
Practice Address - Fax:425-487-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH1439314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4114393Medicaid
WA4114393Medicaid