1497951651 NPI number — FAMILY HOME CARE CORPORATION

Table of content: (NPI 1689893950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497951651 NPI number — FAMILY HOME CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HOME CARE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497951651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22820 E APPLEWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTY LAKE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99019-9514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-473-4900
Provider Business Mailing Address Fax Number:
509-755-4987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22820 E APPLEWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99019-9514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-473-4900
Provider Business Practice Location Address Fax Number:
509-755-4987
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
509-755-4904

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  IS280 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 783884 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9052200 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9050949 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0147269 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7330095 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9055120 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23173 . This is a "GROUP HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1128 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7408065 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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