Organization
WEEPING RIDGE LAKE SPOKANE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISRAEL RODRIGUEZ JR. (ADMINISTRATOR)
(509) 989-1843
Entity
Organization
Contact information
Practice address
12402 OSPREY RD, NINE MILE FALLS, WA 99026-5000
(509) 989-1843
Mailing address
12402 OSPREY RD, NINE MILE FALLS, WA 99026-5000
(509) 989-1843
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123456
MEDICAID AND MEDICARE
WA
Enumeration date
02/05/2015
Last updated
02/05/2015
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