Provider Demographics
NPI:1174740112
Name:SHILOH CARE INC
Entity type:Organization
Organization Name:SHILOH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-643-4669
Mailing Address - Street 1:16505 SE 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5625
Mailing Address - Country:US
Mailing Address - Phone:425-643-4669
Mailing Address - Fax:425-643-8693
Practice Address - Street 1:16505 SE 30TH ST
Practice Address - Street 2:UNIT 1
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-5625
Practice Address - Country:US
Practice Address - Phone:425-643-4669
Practice Address - Fax:425-643-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA300503311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home