# INDEPENDENCE REHAB LLC

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

## Provider details

- **NPI number:** 1588043020
- **Authorized official:** CHAD FULLMER (SENIOR VICE PRESIDENT)
- **Authorized official phone:** (801) 426-4905

## Contact information

- **Practice address:** 919 109TH AVE NE, BELLEVUE, WA 98004-4485
- **Practice address phone:** (425) 233-8766
- **Mailing address:** 12123 NE 172ND PL, M201, BOTHELL, WA 98011-6409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | LL60391131 | WA | Yes |

## Other

- **Enumeration date:** 05/28/2015
- **Last updated:** 05/28/2015