Healthcare Provider Details

I. General information

NPI: 1275536757
Provider Name (Legal Business Name): FAMILY HOME CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22820 E APPLEWAY
LIBERTY LAKE WA
99019-9514
US

IV. Provider business mailing address

22820 E APPLEWAY
LIBERTY LAKE WA
99019-9514
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-4900
  • Fax: 509-755-4974
Mailing address:
  • Phone: 509-473-4900
  • Fax: 509-755-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberIS281
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberIS280
License Number StateWA

VIII. Authorized Official

Name: MR. JEFFREY R KOLCUM
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 509-473-4900