Provider Demographics
NPI:1205546579
Name:OLYMPIC MARMOT HEALTHCARE LLC
Entity type:Organization
Organization Name:OLYMPIC MARMOT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-487-9500
Mailing Address - Street 1:29222 RANCHO VIEJO RD STE 127
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1049
Mailing Address - Country:US
Mailing Address - Phone:949-487-9500
Mailing Address - Fax:
Practice Address - Street 1:560 LEBO BLVD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2617
Practice Address - Country:US
Practice Address - Phone:360-479-1515
Practice Address - Fax:360-479-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility