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MANOR CARE OF LACEY WA ASSOCIATION NPI 1952671505


NPI Information

NPI: 1952671505
Provider Name: MANOR CARE OF LACEY WA, ASSOCIATION

Doing Business As: PROMEDICA SKILLED NURSING AND REHABILITATION (LACEY)

Classification: Skilled Nursing Facility - 314000000X
Entity Type: Organization

CLIA Number: 50D2034884

Address:
4524 INTELCO LOOP SE
LACEY, WA
ZIP 98503
Phone: (360) 491-9884
Get Directions

MANOR CARE OF LACEY WA, ASSOCIATION is a skilled nursing facility in Lacey, WA. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. MANOR CARE OF LACEY WA, ASSOCIATION NPI is 1952671505. The provider is registered as an organization entity type.
The provider Is Doing Business As Promedica Skilled Nursing And Rehabilitation (lacey).

The provider's business location address is:

4524 INTELCO LOOP SE
LACEY, WA
ZIP 98503-941
Phone: (360) 491-9884
Fax: (360) 459-9836

The provider's authorized official is Martin D Allen .
The authorized official title is Director and has the following contact phone number (419) 252-5734.

The CLIA number assigned to this NPI record is 50D2034884 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/12/2012 and was last updated on 2/11/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1314000000XSkilled Nursing FacilityWASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
14114484MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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