Provider Demographics
NPI:1982920112
Name:AHC OF BOTHELL LLC
Entity Type:Organization
Organization Name:AHC OF BOTHELL LLC
Other - Org Name:ADVANCED HEALTH CARE OF BOTHELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-670-5700
Mailing Address - Street 1:215 N WHITLEY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2705
Mailing Address - Country:US
Mailing Address - Phone:208-452-6392
Mailing Address - Fax:208-452-2234
Practice Address - Street 1:707 228TH ST SW
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9733
Practice Address - Country:US
Practice Address - Phone:425-481-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility