Healthcare Provider Details

I. General information

NPI: 1851992366
Provider Name (Legal Business Name): HONOR SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 3RD AVE, STE S101
LONGVIEW WA
98632
US

IV. Provider business mailing address

1135 3RD AVE, STE S101
LONGVIEW WA
98632
US

V. Phone/Fax

Practice location:
  • Phone: 360-952-3100
  • Fax: 360-952-3098
Mailing address:
  • Phone: 360-952-3100
  • Fax: 360-952-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS JON CROSBY
Title or Position: CEO
Credential:
Phone: 360-951-3421