# MANOR PARK HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Park Manor Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558360024
- **Authorized official:** SOON BURNAM (TREASURER)
- **Authorized official phone:** (949) 540-1249

## Contact information

- **Practice address:** 1710 PLAZA WAY, WALLA WALLA, WA 99362-4362
- **Practice address phone:** (509) 529-4218
- **Practice address fax:** (509) 522-1729
- **Mailing address:** 1710 PLAZA WAY, WALLA WALLA, WA 99362-4362
- **Mailing address phone:** (509) 529-4218
- **Mailing address fax:** (509) 522-1729

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | — |
| 314000000X | Skilled Nursing Facility | 1342 | WA | Yes |

## Other

- **Enumeration date:** 07/18/2005
- **Last updated:** 05/23/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4113429 | — | WA |