# 1100 EAST NELSON ROAD OPERATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** COLUMBIA CREST CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417673906
- **Authorized official:** MICHAEL T BERG JD (ASST SECRETARY)
- **Authorized official phone:** (505) 468-4742

## Contact information

- **Practice address:** 1100 E NELSON RD, MOSES LAKE, WA 98837-2360
- **Practice address phone:** (509) 765-6788
- **Mailing address:** 101 E STATE ST, KENNETT SQUARE, PA 19348-3109
- **Mailing address phone:** (610) 444-6350

## Taxonomy

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

## Other

- **Enumeration date:** 10/17/2022
- **Last updated:** 10/17/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4114427 | — | WA |
| 01 | — | 50-5320 | MEDICARE | WA |