Basic Information
| Provider Information | |||||||||
| NPI: | 1154788529 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHINA CREEK VI, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REGENCY NEWCASTLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3326 160TH AVE SE SUITE 120 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256231466 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7454 NEWCASTLE GOLF CLUB RD | ||||||||
| Address2: | |||||||||
| City: | NEWCASTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980599176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254531508 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2016 | ||||||||
| LastUpdateDate: | 01/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | BEDDOE | ||||||||
| AuthorizedOfficialFirstName: | M BART | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4256231466 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 2018 | WA | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.