Provider Demographics
NPI:1720111800
Name:NORTHERN CROSS, LLC
Entity Type:Organization
Organization Name:NORTHERN CROSS, LLC
Other - Org Name:NORTHERN CROSS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:H
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-895-8436
Mailing Address - Street 1:12121 NORTHUP WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1929
Mailing Address - Country:US
Mailing Address - Phone:425-895-8436
Mailing Address - Fax:425-895-8110
Practice Address - Street 1:12121 NORTHUP WAY STE 203
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1929
Practice Address - Country:US
Practice Address - Phone:425-895-8436
Practice Address - Fax:425-895-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602178492261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA504511Medicare Oscar/Certification