Northwest Care-Issaquah, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1407 Issued in WA

Legal business name

NORTHWEST CARE-ISSAQUAH, INC.

Practice address

805 Front St S
Issaquah, WA 98027-4205

Phone

(425) 392-1271

Fax

(425) 557-5563

NPI assigned

Oct 2, 2007

Last updated

Apr 5, 2024By 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

Mr. Marc Johnson

Title

Cfo

Phone

(949) 373-8373

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1629265871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25910 ACERO STE 350",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926917908",
            "telephone_number": "949-441-9258",
            "fax_number": "949-373-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 FRONT ST S",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980274205",
            "telephone_number": "425-392-1271",
            "fax_number": "425-557-5563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST CARE-ISSAQUAH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "949-373-8373",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "1407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4114070",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "505004",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Alison Novosel
• Summer Jo Nowicki, N.D.

• Skilled Nursing Facility in Issaquah, WA
• Providers in Issaquah, 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 Apr 5, 2024; 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.