Provider Demographics
NPI:1881006633
Name:CARE CENTER ELLENSBURG INC
Entity Type:Organization
Organization Name:CARE CENTER ELLENSBURG INC
Other - Org Name:PRESTIGE POST-ACUTE AND REHABILITATION CENTER - KITTITAS VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC V.P. OF FINANCE / PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VISLOCKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-735-7155
Mailing Address - Street 1:7700 NE PARKWAY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6648
Mailing Address - Country:US
Mailing Address - Phone:360-735-7155
Mailing Address - Fax:360-816-8258
Practice Address - Street 1:1050 E MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3930
Practice Address - Country:US
Practice Address - Phone:360-735-7155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTIGE CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility