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Organization
1100 EAST NELSON ROAD OPERATIONS LLC
Active
Organization
1100 EAST NELSON ROAD OPERATIONS LLC
Active
Other names
COLUMBIA CREST CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T BERG JD (ASST SECRETARY)
(505) 468-4742
Entity
Organization
Contact information
Practice address
1100 E NELSON RD, MOSES LAKE, WA 98837-2360
(509) 765-6788
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 444-6350
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4114427
—
WA
01
—
50-5320
MEDICARE
WA
Enumeration date
10/17/2022
Last updated
10/17/2022
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