Provider Demographics
NPI:1679527899
Name:KENNEWICK MEDICAL INVESTORS, LLC
Entity Type:Organization
Organization Name:KENNEWICK MEDICAL INVESTORS, LLC
Other - Org Name:LIFE CARE CENTER OF KENNEWICK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-473-5867
Mailing Address - Street 1:3001 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3713
Mailing Address - Country:US
Mailing Address - Phone:423-473-5751
Mailing Address - Fax:423-339-8342
Practice Address - Street 1:1508 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5260
Practice Address - Country:US
Practice Address - Phone:509-586-9185
Practice Address - Fax:509-586-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH721314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4172102Medicaid
505080Medicare Oscar/Certification