Provider Demographics
NPI:1962496745
Name:NORTH CENTRAL CARE CENTER, INC.
Entity Type:Organization
Organization Name:NORTH CENTRAL CARE CENTER, INC.
Other - Org Name:NORTH CENTRAL CARE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-248-7379
Mailing Address - Street 1:1812 N WALL STREET
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4606
Mailing Address - Country:US
Mailing Address - Phone:509-328-6030
Mailing Address - Fax:509-327-7026
Practice Address - Street 1:1812 N WALL STREET
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4606
Practice Address - Country:US
Practice Address - Phone:509-328-6030
Practice Address - Fax:509-327-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH1144314000000X
WA1144314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4111449Medicaid
WA4111449Medicaid