# RICHMOND BEACH REHAB LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316932114
- **Authorized official:** MARY E. KOFSTAD (CEO)
- **Authorized official phone:** (971) 224-2033

## Contact information

- **Practice address:** 19235 15TH AVE NW, SHORELINE, WA 98177-2725
- **Practice address phone:** (206) 546-2666
- **Practice address fax:** (206) 542-1164
- **Mailing address:** 19235 15TH AVE NW, SHORELINE, WA 98177-2725
- **Mailing address phone:** (206) 546-2666
- **Mailing address fax:** (206) 542-1164

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | WA | Yes |

## Other

- **Enumeration date:** 09/18/2005
- **Last updated:** 07/15/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4113460 | — | WA |