1114153996 NPI number — TOTALCARE HEALTH, LLC

Table of content: (NPI 1114153996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114153996 NPI number — TOTALCARE HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTALCARE HEALTH, LLC
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:
BRIGHTSTAR HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1114153996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12501 BELLEVUE REDMOND RD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-679-0310
Provider Business Mailing Address Fax Number:
425-679-0314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12501 BELLEVUE REDMOND RD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-679-0310
Provider Business Practice Location Address Fax Number:
425-679-0314
Provider Enumeration Date:
06/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HASBUN
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
425-679-0310

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  TO COME , 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: NPOL.NR.60117337 . This is a "DEPT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: IHS.FS.60110982 . This is a "DEPT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".