Provider Demographics
NPI:1679510150
Name:TACOMA CARE CENTER, INC
Entity Type:Organization
Organization Name:TACOMA CARE CENTER, INC
Other - Org Name:TACOMA NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EX VP OF FINANCE / PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VISLOCKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-735-7155
Mailing Address - Street 1:2102 S 96TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-1753
Mailing Address - Country:US
Mailing Address - Phone:253-581-2514
Mailing Address - Fax:253-581-2434
Practice Address - Street 1:2102 S 96TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1753
Practice Address - Country:US
Practice Address - Phone:253-581-2514
Practice Address - Fax:253-581-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1377314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4113775Medicaid
505154Medicare Oscar/Certification