Basic Information
| Provider Information | |||||||||
| NPI: | 1063419190 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRANCISCAN HEALTH SYSTEM CARE CENTER AT TACOMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6220 S. ALASKA ST. | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984081317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534765300 | ||||||||
| FaxNumber: | 2534765365 | ||||||||
| Practice Location | |||||||||
| Address1: | 6220 S. ALASKA ST. | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984081317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534765300 | ||||||||
| FaxNumber: | 2534765365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LARSON | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2534765300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NLT1218 | WA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 4112181 | 05 | WA | MEDICAID |