Basic Information
| Provider Information | |||||||||
| NPI: | 1881796258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGENCY AUBURN, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REGENCY AUBURN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 414 17TH ST SE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980026822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538331740 | ||||||||
| FaxNumber: | 2538332050 | ||||||||
| Practice Location | |||||||||
| Address1: | 414 17TH ST SE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980026822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538331740 | ||||||||
| FaxNumber: | 2538332050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 04/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | BEDDOE | ||||||||
| AuthorizedOfficialFirstName: | M. | ||||||||
| AuthorizedOfficialMiddleName: | BART | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4253924066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | 1195 | WA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 4111951 | 05 | WA | MEDICAID |