Provider Demographics
NPI:1710218656
Name:RICHMOND BEACH REHAB LLC
Entity Type:Organization
Organization Name:RICHMOND BEACH REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:520-591-2919
Mailing Address - Street 1:10014 5TH AVE NE
Mailing Address - Street 2:#302
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7447
Mailing Address - Country:US
Mailing Address - Phone:520-591-2919
Mailing Address - Fax:
Practice Address - Street 1:19235 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2725
Practice Address - Country:US
Practice Address - Phone:206-546-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI 60112795314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility