1669479119 NPI number — METHOW VALLEY HOME HEALTH AGENCY

Table of content: (NPI 1669479119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669479119 NPI number — METHOW VALLEY HOME HEALTH AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHOW VALLEY HOME HEALTH AGENCY
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:
AERO METHOW RESCUE SERVICE
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:
1669479119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 66
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TWISP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98856-0066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-997-4013
Provider Business Mailing Address Fax Number:
509-997-4005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 HWY 20 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWISP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-997-4013
Provider Business Practice Location Address Fax Number:
509-997-4005
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BUTTON
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF SERVICES
Authorized Official Telephone Number:
509-997-4013

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  24X01 , 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: 9162504 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 079815001 . This is a "GROUP HEALTH COOP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 119292700 . This is a "US DOL" identifier . This identifiers is of the category "OTHER".
  • Identifier: ARMRE01091-58655 . This is a "MSC PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012524 . This is a "DEPT. OF LABOR & INDUSTRI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GA0008 . This is a "WV MEDICAL CENTER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 222066222066 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com