Provider Demographics
NPI:1750378402
Name:FIRCREST
Entity type:Organization
Organization Name:FIRCREST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NHA
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:PILKEY
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:206-361-3515
Mailing Address - Street 1:15230 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7130
Mailing Address - Country:US
Mailing Address - Phone:206-361-3511
Mailing Address - Fax:206-361-2997
Practice Address - Street 1:15230 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7130
Practice Address - Country:US
Practice Address - Phone:206-361-3511
Practice Address - Fax:206-361-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4088464Medicaid
WA50A260Medicare ID - Type Unspecified