Provider Demographics
NPI:1801887641
Name:PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST
Entity type:Organization
Organization Name:PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:E
Authorized Official - Last Name:NAHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:206-329-0770
Mailing Address - Street 1:1630 43RD AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-6210
Mailing Address - Country:US
Mailing Address - Phone:206-329-0770
Mailing Address - Fax:206-329-0227
Practice Address - Street 1:1630 43RD AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-6210
Practice Address - Country:US
Practice Address - Phone:206-329-0770
Practice Address - Fax:206-329-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABH 183310400000X
WA489314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4111670Medicaid
WA489OtherNURSING HOME LICENSE
WABH 183OtherBOARDINGHOME LICENSE
WA489OtherNURSING HOME LICENSE