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Organization
817 EAST PLUM STREET OPERATIONS LLC
Active
Organization
817 EAST PLUM STREET OPERATIONS LLC
Active
Other names
LAKE RIDGE 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
817 E PLUM ST, MOSES LAKE, WA 98837-1870
(509) 765-7835
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
—
4114435
—
WA
01
—
505261
MEDICARE
—
Enumeration date
10/17/2022
Last updated
10/17/2022
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