Healthcare Provider Details

I. General information

NPI: 1629288618
Provider Name (Legal Business Name): CAREAGE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14450 NE 29TH PL SUITE 106
BELLEVUE WA
98007-8616
US

IV. Provider business mailing address

PO BOX 1969
GIG HARBOR WA
98335-3969
US

V. Phone/Fax

Practice location:
  • Phone: 425-519-1265
  • Fax: 425-861-7879
Mailing address:
  • Phone: 253-853-4457
  • Fax: 253-853-5280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberIHS.FS.60007888
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KELLY L CALLAHAN
Title or Position: CEO
Credential:
Phone: 253-853-4457