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Organization
HERITAGE GROVE
Active
Organization
HERITAGE GROVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KYLLE FISH M.A. (ADMINISTRATOR)
(509) 248-4173
Entity
Organization
Contact information
Practice address
115 N 10TH ST, YAKIMA, WA 98901-2572
(509) 248-4173
(509) 249-6246
Mailing address
115 N 10TH ST, YAKIMA, WA 98901-2572
(509) 248-4173
(509) 249-6246
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH1291
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4112918
—
WA
Enumeration date
09/07/2005
Last updated
08/22/2020
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