Healthcare Provider Details

I. General information

NPI: 1932723665
Provider Name (Legal Business Name): IN-HOME CARE, NORTHERN SUBURBS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 218TH ST SW STE 308
MOUNTLAKE TERRACE WA
98043-2180
US

IV. Provider business mailing address

6405 218TH ST SW STE 308
MOUNTLAKE TERRACE WA
98043-2180
US

V. Phone/Fax

Practice location:
  • Phone: 425-697-6060
  • Fax: 425-507-2032
Mailing address:
  • Phone: 425-697-6060
  • Fax: 425-507-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BRUCE PHILIP ANDERSON
Title or Position: OWNER
Credential:
Phone: 425-697-6060