CRH Peters Creek LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

2245 Issued in WA

Legal business name

CRH PETERS CREEK LLC

Practice address

14431 Redmond Way
Redmond, WA 98052-4245

Phone

(425) 869-2273

Fax

(425) 861-1876

NPI assigned

Mar 28, 2014

Organization subpart

Yes

Parent organization

CRH NORTHWESTAs reported in NPPES

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

Authorized official

Name

Don Tavolacci

Title

Managing Member

Phone

(541) 317-9188

Specialties & licenses 1

Addresses

Other names 1

• Peters Creek Doing business as

Practitioners 1

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

• Angeleigh Gregorios, OTR/L

  • Gerontology Occupational Therapist
  • Redmond, WA
  • NPI 1215324538
  NPD (past)

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

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633564800000",
    "number": "1356769293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1410",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977091410",
            "telephone_number": "541-317-9188",
            "fax_number": "541-389-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14431 REDMOND WAY",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980524245",
            "telephone_number": "425-869-2273",
            "fax_number": "425-861-1876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRH PETERS CREEK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRH NORTHWEST",
        "enumeration_date": "2014-03-28",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A",
        "authorized_official_last_name": "TAVOLACCI",
        "authorized_official_first_name": "DON",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "541-317-9188"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WA",
            "license": "2245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peters Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Cotarelo Cardenas
• Amy Coverston, OTR
• Marla J Cox, OTR/L
• Craig M Burns LLC
• Kyle Crawford, DPT
• Kenneth Fredrick Crinklaw, MSPT, OCS
• Richard A Crinzi, DDS MS
• Pamela Elaine Cripe
• Jillian Barbara Cromar
• Kevin W Crosby

• Assisted Living Facility in Redmond, WA
• Providers in Redmond, WA by specialty
• Assisted Living Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; 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.