Revera (Delaware) LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1257 Issued in WA

Legal business name

REVERA (DELAWARE) LLC

Doing business as

Linden Grove Health Care Center

Practice address

400 29TH Street NE
Puyallup, WA 98372-6774

Phone

(253) 840-4400

Fax

(253) 840-6733

NPI assigned

Aug 15, 2005

Last updated

May 19, 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

(860) 347-6300

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Linden Grove Health Care Center Doing business as

Locations

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305763200000",
    "number": "1417959875",
    "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": "400 29TH STREET NE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983726774",
            "telephone_number": "253-840-4400",
            "fax_number": "253-840-6733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERA (DELAWARE) LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2011-05-19",
        "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": "860-347-6300"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "NH1257",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "1257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112579",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Linden Grove Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Puyallup, WA
• Providers in Puyallup, 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 19, 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.