Provider Demographics
NPI:1316280019
Name:VIDELL HEALTHCARE SPRINGSIDE, L.L.C.
Entity type:Organization
Organization Name:VIDELL HEALTHCARE SPRINGSIDE, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY GENERAL COUNSEL
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WESTFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-277-3197
Mailing Address - Street 1:16400 SOUTHCENTER PARKWAY, SUITE 208
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3383
Mailing Address - Country:US
Mailing Address - Phone:253-277-3197
Mailing Address - Fax:253-220-8442
Practice Address - Street 1:255 LEBANON AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7828
Practice Address - Country:US
Practice Address - Phone:413-499-2334
Practice Address - Fax:413-443-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility