Provider Demographics
NPI: | 1699028282 |
---|---|
Name: | VIDELL HEALTHCARE CRANEVILLE, LLC |
Entity Type: | Organization |
Organization Name: | VIDELL HEALTHCARE CRANEVILLE, LLC |
Other - Org Name: | CRANEVILLE PLACE REHABILITATION AND SKILLED CARE CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEPHEN |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | LAFORTE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 253-277-3197 |
Mailing Address - Street 1: | 16400 SOUTHCENTER PKWY |
Mailing Address - Street 2: | SUITE 208 |
Mailing Address - City: | TUKWILA |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98188-3335 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-277-3197 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 265 MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | DALTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01226-1614 |
Practice Address - Country: | US |
Practice Address - Phone: | 413-684-3212 |
Practice Address - Fax: | 413-684-2033 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-10-19 |
Last Update Date: | 2012-10-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |