Provider Demographics
NPI:1851804959
Name:TALBOT REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:TALBOT REHABILITATION CENTER, LLC
Other - Org Name:TALBOT CENTER FOR REHABILITATION AND HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-936-6000
Mailing Address - Street 1:230 N. MARYLAND AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206
Mailing Address - Country:US
Mailing Address - Phone:323-936-6000
Mailing Address - Fax:323-936-6004
Practice Address - Street 1:4430 TALBOT ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-226-7500
Practice Address - Fax:425-793-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA505202OtherCMS CERTIFICATION NUMBER