NPIMap

Organization Active NPI

Independence Rehab LLC

  • Skilled Nursing Facility
  • Bellevue, WA
National Provider Identifier
1588043020
Registry record updated May 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
LL60391131 Issued in WA
Legal business name
INDEPENDENCE REHAB LLC
Practice address
919 109TH Ave NE
Bellevue, WA 98004-4485
Phone
(425) 233-8766
NPI assigned
May 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2015

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

Authorized official

Name
Chad Fullmer
Title
Senior Vice President
Phone
(801) 426-4905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X LL60391131 WA Primary

Addresses

Primary practice location

919 109TH Ave NE
Bellevue, WA 98004-4485

Mailing address

12123 NE 172ND PL
M201
Bothell, WA 98011-6409

National Provider Directory

National Provider Directory
Tax ID family
Independence Rehab3 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.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432771200000",
    "number": "1588043020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12123 NE 172ND PL",
            "address_2": "M201",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980116409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 109TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044485",
            "telephone_number": "425-233-8766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-28",
        "last_updated": "2015-05-28",
        "status": "A",
        "authorized_official_last_name": "FULLMER",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "801-426-4905"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "LL60391131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2015; 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.