Revera (Delaware) LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1259 Issued in WA

Legal business name

REVERA (DELAWARE) LLC

Doing business as

Orchard Park Health and Rehabilitation Center

Practice address

4755 S 48TH Street
Tacoma, WA 98409-1919

Phone

(253) 475-4611

Fax

(253) 471-9591

NPI assigned

Nov 2, 2005

Last updated

May 20, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carole M Scillia

Title

LLC Manager

Phone

(203) 608-6100

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Orchard Park Health and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305849600000",
    "number": "1225029887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 PRESTON AVE",
            "address_2": "SUITE 270",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064504851",
            "telephone_number": "203-608-6100",
            "fax_number": "203-639-3574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 S 48TH STREET",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984091919",
            "telephone_number": "253-475-4611",
            "fax_number": "253-471-9591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERA (DELAWARE) LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2011-05-20",
        "status": "A",
        "authorized_official_last_name": "SCILLIA",
        "authorized_official_first_name": "CAROLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "LLC MANAGER",
        "authorized_official_telephone_number": "203-608-6100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "NH1259",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "1259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112595",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orchard Park Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.