# STAFFORD HEALTHCARE, SEATAC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Stafford Healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962493247
- **Authorized official:** MR. JAMES KENNETH BENNETT JR. MHA (VICE PRESIDENT OF OPERATIONS)
- **Authorized official phone:** (206) 824-0600

## Contact information

- **Practice address:** 2800 SOUTH 224TH ST, DES MOINES, WA 98198-5132
- **Practice address phone:** (206) 824-0600
- **Practice address fax:** (206) 824-5622
- **Mailing address:** 2800 SOUTH 224TH ST, DES MOINES, WA 96198-5132
- **Mailing address phone:** (206) 824-0600
- **Mailing address fax:** (206) 824-5622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 1364 | WA | Yes |

## Other

- **Enumeration date:** 11/04/2005
- **Last updated:** 12/08/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4113613 | — | WA |
| 05 | — | 4113643 | — | WA |