Healthcare Provider Details

I. General information

NPI: 1619141538
Provider Name (Legal Business Name): COMPREHENSIVE HOME & COMPANION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21907 64TH AVE W #230
MOUNTLAKE TERRACE WA
98043-2200
US

IV. Provider business mailing address

21907 64TH AVE W #230
MOUNTLAKE TERRACE WA
98043-2200
US

V. Phone/Fax

Practice location:
  • Phone: 425-275-5858
  • Fax: 425-275-5855
Mailing address:
  • Phone: 425-275-5858
  • Fax: 425-275-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberIS-184
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberIS-184
License Number StateWA

VIII. Authorized Official

Name: DR. EVAN CANTINI
Title or Position: MEDICAL DIRECTOR & PRESIDENT
Credential: MD
Phone: 425-275-5858