Basic Information
Provider Information
NPI: 1508379827
EntityType: 2
ReplacementNPI:  
OrganizationName: BREMERTON HEALTH, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: BREMERTON CONVALESCENT & REHABILITATION CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3220 ROSEDALE ST NW STE 200
Address2:  
City: GIG HARBOR
State: WA
PostalCode: 983351837
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2701 CLARE AVE
Address2:  
City: BREMERTON
State: WA
PostalCode: 983103313
CountryCode: US
TelephoneNumber: 3603773951
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/08/2017
LastUpdateDate: 11/08/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: OSCHEROWITZ
AuthorizedOfficialFirstName: ELI
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: MANAGER
AuthorizedOfficialTelephone: 3236784426
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X  Y Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


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