Provider Demographics
NPI:1063808574
Name:TEKOA OPERATIONS LLC TEKOA CARE CENTER
Entity type:Organization
Organization Name:TEKOA OPERATIONS LLC TEKOA CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:CALE
Authorized Official - Last Name:WESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-326-0623
Mailing Address - Street 1:330 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TEKOA
Mailing Address - State:WA
Mailing Address - Zip Code:99033-9772
Mailing Address - Country:US
Mailing Address - Phone:707-326-0623
Mailing Address - Fax:866-924-5211
Practice Address - Street 1:330 N MADISON ST
Practice Address - Street 2:
Practice Address - City:TEKOA
Practice Address - State:WA
Practice Address - Zip Code:99033-9772
Practice Address - Country:US
Practice Address - Phone:707-326-0623
Practice Address - Fax:866-924-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility