NPIMap

Organization Active NPI

Covenant Living West

  • Skilled Nursing Facility
  • Mercer Island, WA
National Provider Identifier
1023190824
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1231 Issued in WA
Legal business name
COVENANT LIVING WEST
Practice address
9107 Fortuna Dr
Mercer Island, WA 98040-3132
Phone
(206) 268-3000
Fax
(206) 236-1438
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Authorized official

Name
Elizabeth Malzahn
Title
Vice President of Health Services
Phone
(773) 878-4430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1231 WA Primary

Addresses

Primary practice location

9107 Fortuna Dr
Mercer Island, WA 98040-3132

Mailing address

9150 Fortuna Drive
Mercer Island, WA 98040-3133
Phone (206) 268-3000

Other identifiers 1

IdentifierTypeStateIssuer
4112314MedicaidWA

Other names 1

  • Covenant Shores Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100324000425 WA Part A Provider - Skilled Nursing Facility 3870634884 Practice locations: Mercer Island, WA

Skilled nursing facility certification: CCN 505504

Legal name
COVENANT LIVING WEST
Doing business as
COVENANT SHORES HEALTH CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 4, 1997
Last certification
Dec 16, 2024
Beds
43
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Covenant Living West
Organization structure
CorporationNon-profit
Incorporated
Dec 23, 1975 in WA
Enrollment address
9150 Fortuna Dr
Mercer Island, WA 98040-3133
Nursing home name
COVENANT SHORES HEALTH CENTER
Affiliated entity
COVENANT LIVING

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Covenant Shores Health CenterCCN 505504
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Sep 4, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4338.2 residents per day on average
Chain
Covenant Living15 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D0932777Covenant Shores Health Center9107 Fortuna Drive, Mercer Island, WA 98040Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Brandel Manor6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

9107 Fortuna Dr
Mercer Island, WA 98040
Phone (206) 268-3000

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Marc E Espinosa Individual Operational/Managerial ControlBoard Member Jul 1, 2012
Donald Hodgkinson Individual Operational/Managerial ControlBoard Member Jul 1, 2012
Covenant Living Communities & Services Organization, Skokie, IL Non-profit Operational/Managerial Control Dec 23, 1975 100%
Roger Oxendale Individual Operational/Managerial ControlBoard Member Jul 1, 2017
Anne E Vining Individual Operational/Managerial ControlBoard Member Jul 1, 2012
David Erickson Individual Corporate OfficerSenior Vice President Jan 31, 2008
Marlene E Stante Individual Operational/Managerial ControlBoard Member Jul 1, 2012
Terri Cunliffe Individual Corporate OfficerSenior Vice President Mar 1, 2010
W-2 Managing EmployeeSenior Vice President Mar 19, 2009
Mark C Eastburg Individual Operational/Managerial ControlBoard Member Jul 1, 2012
Matt Manlove Individual Operational/Managerial ControlBoard Member Jul 1, 2017
Jody Holt Individual Corporate OfficerCfo Jun 2, 2017

Facilities with the same owner 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 5

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": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564444800000",
    "number": "1023190824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9150 FORTUNA DRIVE",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980403133",
            "telephone_number": "206-268-3000",
            "fax_number": "206-236-1438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9107 FORTUNA DR",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980403132",
            "telephone_number": "206-268-3000",
            "fax_number": "206-236-1438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT LIVING WEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2019-07-30",
        "status": "A",
        "authorized_official_last_name": "MALZAHN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "VICE PRESIDENT OF HEALTH SERVICES",
        "authorized_official_telephone_number": "773-878-4430"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "1231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112314",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Covenant Shores Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Covenant Shores Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mercer Island, WA

Sources for this page

Verify at the official NPI Registry.