Healthcare Provider Details

I. General information

NPI: 1902892615
Provider Name (Legal Business Name): HOQUIAM HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 CHERRY ST
HOQUIAM WA
98550-3007
US

IV. Provider business mailing address

3035 CHERRY ST
HOQUIAM WA
98550-3007
US

V. Phone/Fax

Practice location:
  • Phone: 360-532-7882
  • Fax: 360-537-7216
Mailing address:
  • Phone: 360-532-7882
  • Fax: 360-537-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1347
License Number StateWA

VIII. Authorized Official

Name: MRS. SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249