Provider Demographics
NPI:1538159702
Name:STATE OF WASHINGTON, WASHINGTON VETERANS HOMES
Entity type:Organization
Organization Name:STATE OF WASHINGTON, WASHINGTON VETERANS HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-725-2152
Mailing Address - Street 1:1141 BEACH DR E
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4937
Mailing Address - Country:US
Mailing Address - Phone:360-895-4700
Mailing Address - Fax:360-895-4453
Practice Address - Street 1:1141 BEACH DR E
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4937
Practice Address - Country:US
Practice Address - Phone:360-895-4700
Practice Address - Fax:360-895-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA310400000X, 313M00000X, 314000000X
WAN/A313M00000X, 310400000X
WANOT APPLICABLE314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
50-5517OtherMEDICARE A
WA7102411Medicaid
WA4000006Medicaid
G000200606Medicare PIN
WA505517Medicare Oscar/Certification
WAG000200606Medicare PIN