Provider Demographics
NPI:1174097224
Name:BFG OLYMPIA PROPCO III, LLC
Entity type:Organization
Organization Name:BFG OLYMPIA PROPCO III, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-426-2756
Mailing Address - Street 1:506 N 40TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-4330
Mailing Address - Country:US
Mailing Address - Phone:509-426-2756
Mailing Address - Fax:
Practice Address - Street 1:710 FIELDSTONE DR SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5500
Practice Address - Country:US
Practice Address - Phone:360-250-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPENDINGMedicaid