THE TERRACE AT BEVERLY LAKE MC GR, LLC
NPI 1922624311
Assisted Living Facility in Everett, WA

Active since June 22, 2020CLIA 50D2220619 · Waiver
524 75TH ST SE, EVERETT, WA 98203(425) 348-8800 Get Directions Write a Review

NPPES record last updated: June 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About The Terrace At Beverly Lake Mc Gr, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THE TERRACE AT BEVERLY LAKE MC GR, LLC (NPI 1922624311), doing business as Terrace At Beverly Lake, is a healthcare organization registered as an assisted living facility in Everett, Washington and active in the NPI registry since June 2020. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Gregory Roderick, Member, as its authorized official.

NPPES Registry Identity

NPI1922624311
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameTHE TERRACE AT BEVERLY LAKE MC GR, LLC
Location Address524 75TH ST SEEverett, WA 98203-5512
Mailing Address7420 Sw Bridgeport Rd Ste 105Portland, OR 97224-7790 · (503) 597-4906
Organization SubpartNo
Authorized OfficialGregory RoderickMember · (503) 443-1818
Enumeration DateJune 22, 2020
NPPES CertifiedJune 22, 2020
NPI 1922624311 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
524 75TH ST SE, Everett, WA 98203

Other Names 1

Doing Business AsTerrace At Beverly Lake

Other Identifiers 1

Medicaid202779WA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2220619

The Terrace At Beverly Lake · Everett, WA
Active · expires Apr 4, 2028
CLIA Number50D2220619
Laboratory TypeAssisted Living Facility
Certificate Effective DateApril 13, 2021
Certificate Expiration DateApril 4, 2028
Laboratory DirectorCory Peganyee
Laboratory Phone(425) 348-8800
Laboratory LocationThe Terrace At Beverly Lake524 75th St SE, Everett, WA 98203
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is The Terrace At Beverly Lake Mc Gr, LLC's NPI number?

The NPI number for The Terrace At Beverly Lake Mc Gr, LLC is 1922624311. It was assigned to this organization in the NPPES registry on June 22, 2020. The provider is doing business as Terrace at Beverly Lake.

Where is The Terrace At Beverly Lake Mc Gr, LLC located?

The Terrace At Beverly Lake Mc Gr, LLC is located at 524 75th St SE, Everett, WA 98203. The listed phone number is (425) 348-8800.

What is The Terrace At Beverly Lake Mc Gr, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does The Terrace At Beverly Lake Mc Gr, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2220619) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for The Terrace At Beverly Lake Mc Gr, LLC was last updated on June 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.