Organization
LIFE CARE AT HOME OF WASHINGTON, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM RAU (VP OF FINANACE)
(423) 473-5280
Entity
Organization
Contact information
Practice address
505 CEDAR AVE, B-1, MARYSVILLE, WA 98270-4561
(360) 659-1487
(360) 659-0726
Mailing address
3001 KEITH ST NW, P O BOX 3480, CLEVELAND, TN 37312-3713
(423) 473-5256
(423) 339-8356
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
IS364
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1116
PREMERA BLUE CROSS
WA
05
—
9044900
—
WA
Enumeration date
06/23/2005
Last updated
01/29/2013
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