Organization
CARITAS CRITICAL CASE MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONY BLACKMOM-HUMPHREY RN, CCM (REGISTERED NURSE)
(206) 207-9363
Entity
Organization
Contact information
Practice address
23205 SE BLACK NUGGET RD, APT J2, ISSAQUAH, WA 98029-7326
(206) 207-9363
Mailing address
23205 SE BLACK NUGGET RD, APT J2, ISSAQUAH, WA 98029-7326
(206) 207-9363
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN60625891
WA
163WC0400X
Case Management Registered Nurse
Primary
4219311
NJ
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN60625891
WA
Other
Enumeration date
04/24/2017
Last updated
04/24/2017
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