Provider Demographics
NPI:1730518531
Name:EXTENDICARE NORTH AUBURN REHABILITATION
Entity type:Organization
Organization Name:EXTENDICARE NORTH AUBURN REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OCCUPATIONAL THERAPY ASST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TENISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-229-7418
Mailing Address - Street 1:2830 I ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-2410
Mailing Address - Country:US
Mailing Address - Phone:253-561-8100
Mailing Address - Fax:253-333-1718
Practice Address - Street 1:2830 I ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-2410
Practice Address - Country:US
Practice Address - Phone:253-561-8100
Practice Address - Fax:253-333-1718
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXTENDICARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60282758305R00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1811061518Medicaid