Washington Odd Fellows Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH351 Issued in WA

Legal business name

WASHINGTON ODD FELLOWS HOME

Practice address

534 Boyer Avenue
Walla Walla, WA 99362

Phone

(509) 525-6463

Fax

(509) 526-6883

NPI assigned

Oct 26, 2005

Last updated

Feb 23, 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

John R Brigham

Title

Administrator

Phone

(509) 525-6463

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639169097. Details of each certification follow.

• CCN 505421 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 505421

Legal name

WASHINGTON ODD FELLOWS HOME

Doing business as

CBSI

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1992

Last certification

Jul 23, 2024

Beds

53

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Aug 1, 1990 in WA

Enrollment address

534 Boyer Ave
Walla Walla, WA 99362-2047

Nursing home name

WASHINGTON ODD FELLOWS HOME

Listed as

Washington Odd Fellows HomeCCN 505421 · All quality measures

Overall star rating

4 of 5

Health inspections

3 of 5

Staffing

3 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Jan 1, 1992

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5346.4 residents per day on average

Penalties (3 years)

1Fines totaling $67,616

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Washington Odd Fellows Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Washington Odd Fellows Home

  • Assisted Living Facility
  • Walla Walla, WA
  • NPI 1114917630
  NPD tax ID

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• F&M Healthcare, LLC

  dba F&M Healthcare

  • Internal Medicine Physician
  • University Place, WA
  • NPI 1861145120

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Floyd Sekeramayi, M.D.

  • Internal Medicine Physician
  • Tacoma, WA
  • NPI 1912324559

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Patricia Ann Coyman, DO

  • Geriatric Medicine (Family Medicine) Physician
  • Yakima, WA
  • NPI 1285661942
  NPD (past)
• Floyd Sekeramayi, M.D.

  • Internal Medicine Physician
  • Tacoma, WA
  • NPI 1912324559
  NPD (past)

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Patricia Ann Coyman, DO

  • Geriatric Medicine (Family Medicine) Physician
  • Yakima, WA
  • NPI 1285661942

  Nursing home

  Care Compare affiliation
• John Casey Heffernan, DO

  • Internal Medicine Physician
  • Walla Walla, WA
  • NPI 1750818019

  Nursing home

  Care Compare affiliation
• Joanne Lynn Nunez Perez, M.D.

  • Internal Medicine Physician
  • Walla Walla, WA
  • NPI 1467643619

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298419200000",
    "number": "1639169097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "534 BOYER AVENUE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "99362",
            "telephone_number": "509-525-6463",
            "fax_number": "509-526-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 BOYER AVENUE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "99362",
            "telephone_number": "509-525-6463",
            "fax_number": "509-526-6883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON ODD FELLOWS HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2011-02-23",
        "status": "A",
        "authorized_official_last_name": "BRIGHAM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-525-6463"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "NH351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4135109",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1015156",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Katriona Wardall, PHARMD
• George Robert Waring, MD
• Patricia Ann Waring, MD
• Jody Washburn
• Washington Odd Fellows Home
• Washington State Department of Corrections-Washington State Penitentia
• Washington State Walla Walla Veterans Home
• Michelle Watilo, OTR/L
• Jenna Rae Watts, RN
• Catelyn J Webber

• Skilled Nursing Facility in Walla Walla, WA
• Providers in Walla Walla, 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 Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.