Provider Demographics
NPI:1710028303
Name:PARKWAY NORTH CARE CENTER
Entity Type:Organization
Organization Name:PARKWAY NORTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THIEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-285-3883
Mailing Address - Street 1:510 N PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-8004
Mailing Address - Country:US
Mailing Address - Phone:425-285-3883
Mailing Address - Fax:425-285-3887
Practice Address - Street 1:12015 115TH AVE NE
Practice Address - Street 2:BLDG E SUITE 195
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6940
Practice Address - Country:US
Practice Address - Phone:425-285-3883
Practice Address - Fax:425-285-3887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-08
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1406314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4112298Medicaid
WA505331Medicare Oscar/Certification