Provider Demographics
NPI:1922548825
Name:WAATU, INC.
Entity Type:Organization
Organization Name:WAATU, INC.
Other - Org Name:SHUKSAN HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-293-3174
Mailing Address - Street 1:1105 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2710
Mailing Address - Country:US
Mailing Address - Phone:360-293-3174
Mailing Address - Fax:360-293-4418
Practice Address - Street 1:1530 JAMES ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4945
Practice Address - Country:US
Practice Address - Phone:360-733-9161
Practice Address - Fax:360-715-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1314314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4113148Medicaid
WA4113148Medicaid