Provider Demographics
NPI:1194358572
Name:ABBEY ROAD CARE HOME LLC
Entity type:Organization
Organization Name:ABBEY ROAD CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:THUO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:978-397-2282
Mailing Address - Street 1:11722 NE 134TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2130
Mailing Address - Country:US
Mailing Address - Phone:425-821-2838
Mailing Address - Fax:425-522-4394
Practice Address - Street 1:11722 NE 134TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2130
Practice Address - Country:US
Practice Address - Phone:425-821-2838
Practice Address - Fax:425-522-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2134819Medicaid