# PUGET SOUND HEALTHCARE - OLYMPIA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Puget Sound Healthcare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629142294
- **Authorized official:** MR. DOV E. JACOBS (MANAGER)
- **Authorized official phone:** (323) 678-4426

## Contact information

- **Practice address:** 4001 CAPITOL MALL DR SW, OLYMPIA, WA 98502-8657
- **Practice address phone:** (360) 754-9792
- **Practice address fax:** (360) 754-2455
- **Mailing address:** 4001 CAPITOL MALL DRIVE SW, OLYMPIA, WA 98502-8657
- **Mailing address phone:** (360) 754-9792
- **Mailing address fax:** (360) 754-2455

## Taxonomy

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

## Other

- **Enumeration date:** 11/17/2006
- **Last updated:** 08/18/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4110102 | — | WA |