1285202994 NPI number — BETHANY HOME HEALTH LLC

Table of content: (NPI 1285202994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285202994 NPI number — BETHANY HOME HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHANY HOME 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:
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:
1285202994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILL CREEK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98082-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-332-4475
Provider Business Mailing Address Fax Number:
425-332-4475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1902 120TH PL SE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98208-6292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-338-3000
Provider Business Practice Location Address Fax Number:
425-740-0426
Provider Enumeration Date:
06/17/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BAUGUESS
Authorized Official First Name:
TRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE MANAGEMENT
Authorized Official Telephone Number:
425-332-4475

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2224744 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: IHS.FS.60966822 . This is a "WA STATE DEPT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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