NPIMap

Organization Active NPI

Bethany of the Northwest

Doing business as Bethany at Pacific

  • Skilled Nursing Facility
  • Everett, WA
National Provider Identifier
1003879800
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
313007682 Issued in WA
Legal business name
BETHANY OF THE NORTHWEST
Doing business as
Bethany at Pacific
Practice address
916 Pacific Avenue
Everett, WA 98201
Phone
(425) 259-5508
Fax
(425) 258-5656
NPI assigned
Apr 11, 2006
Last updated
Jul 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joseph Scrivens
Title
Ceo
Phone
(425) 551-6400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 313007682 WA Primary

Addresses

Primary practice location

916 Pacific Avenue
Everett, WA 98201

Mailing address

PO Box 13700
Mill Creek, WA 98082-1700
Phone (425) 332-4475

Other identifiers 1

IdentifierTypeStateIssuer
4112900MedicaidWA

Other names 1

  • Bethany at Pacific Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100224000646 WA Part A Provider - Skilled Nursing Facility 5597710475 Practice locations: Everett, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003879800. Details of each certification follow.

Skilled nursing facility certification: CCN 505404

Legal name
BETHANY OF THE NORTHWEST
Doing business as
BETHANY AT PACIFIC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1992
Last certification
Apr 21, 2025
Beds
80
Ownership / control type
Other Nonprofit
Multi-facility organization
Bethany of the Northwest
Organization structure
CorporationNon-profit
Incorporated
Dec 5, 1901 in WA
Enrollment address
916 Pacific Ave
Everett, WA 98201-4147
Nursing home name
BETHANY AT PACIFIC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bethany At PacificCCN 505404 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Other
Certified
Jan 1, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8074.0 residents per day on average
Penalties (3 years)
1Fines totaling $42,477

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Bethany of the Northwest3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Harpreet S Mann Individual Operational/Managerial Control Feb 25, 2025
Adp of the SNF Feb 1, 2022
Jeff F Gay Individual Corporate DirectorBoard Member Apr 27, 2017 7.14%
Loren J Ihle Individual Corporate Director Jan 23, 2025 7.14%
Susan O Tiu Individual Corporate DirectorBoard Member Jan 3, 2019 7.14%
Mahdiesadat Seyed Aliroteh Individual Corporate Director Apr 4, 2024 7.14%
Steven C Jacobson Individual Corporate DirectorBoard President Jun 27, 2018 7.18%
Tom Rohde Individual Corporate DirectorBoard Member Jun 7, 2018 7.14%
Bethany of the Northwest Organization, Everett, WA Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Oct 12, 1999 100%
Adp of the SNF Jan 22, 2025
Veronica Knudson Individual Corporate Director Jan 23, 2025 7.14%
Lawrence B Stave Individual Corporate Director Jan 23, 2025 7.14%
Tristine C Bauguess Individual Operational/Managerial Control Feb 25, 2025
Adp of the SNF Mar 22, 2017
Joseph R Scrivens Individual Corporate OfficerCeo Dec 6, 2019 100%
Operational/Managerial Control Dec 6, 2019
Adp of the SNF Dec 6, 2019
Robert C Dobler Individual Corporate Director Jan 23, 2025 7.14%
Janice E Nesse Individual Corporate Director Jan 23, 2025 7.14%
Terri K Wallin Individual Corporate DirectorBoard Member Jul 23, 2020 7.14%
Marlita G Basada Individual Operational/Managerial Control May 1, 2024
Adp of the SNF May 1, 2024
Patricia M Degroodt Individual Corporate Director Feb 1, 2023 7.14%
Eric D Nicholson Individual Corporate DirectorTreasurer Oct 26, 2023 7.14%
David R Koenig Individual Corporate DirectorBoard Vice President Mar 1, 2007 7.14%

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bethany at Silver LakeEverett, WA, CCN 505403 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF
Direct Ownership Interest (100%)		 Oct 12, 1999
Jan 21, 2025
Oct 12, 1999
Providence Health Service-WaEverett, WA, CCN 505533 Skilled nursing facility 5% Or Greater Direct Ownership Interest (50%)
Operational/Managerial Control
Adp of the SNF		 Jan 5, 1995
Apr 1, 2020
Feb 27, 2025
Bethany Home Health LLCEverett, WA, CCN 507135 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 22, 2019
Dec 6, 2019
Bethany Hospice LLCEverett, WA, CCN 501564 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 2, 2021
Feb 2, 2021

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1003879800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13700",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980821700",
            "telephone_number": "425-332-4475",
            "fax_number": "425-740-0426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 PACIFIC AVENUE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "98201",
            "telephone_number": "425-259-5508",
            "fax_number": "425-258-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY OF THE NORTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "SCRIVENS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-551-6400"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "313007682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112900",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethany at Pacific",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bethany at Pacific",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.