Healthcare Provider Details

I. General information

NPI: 1407858681
Provider Name (Legal Business Name): BESSIE BURTON SULLIVAN HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 156TH AVE NE
BELLEVUE WA
98007-3814
US

IV. Provider business mailing address

1020 E JEFFERSON ST
SEATTLE WA
98122-5336
US

V. Phone/Fax

Practice location:
  • Phone: 425-519-1265
  • Fax: 425-641-1115
Mailing address:
  • Phone: 206-328-7850
  • Fax: 206-568-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberIS- 234
License Number StateWA

VIII. Authorized Official

Name: MS. DOROTHY R GRAINGER
Title or Position: EXECUTIVE DIRECTOR
Credential: RN, MSN, MBA
Phone: 206-328-7850