Provider Demographics
NPI:1457529950
Name:TRILOGY HEALTHCARE OF BELLEVUE, LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OF BELLEVUE, LLC
Other - Org Name:THE WILLOWS AT BELLEVUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP - FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:101 AUXILIARY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-1028
Mailing Address - Country:US
Mailing Address - Phone:419-483-5000
Mailing Address - Fax:419-483-5022
Practice Address - Street 1:101 AUXILIARY DRIVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-1028
Practice Address - Country:US
Practice Address - Phone:419-483-5000
Practice Address - Fax:419-483-5022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPENDING314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHPENDINGMedicare Oscar/Certification