Healthcare Provider Details

I. General information

NPI: 1275450892
Provider Name (Legal Business Name): SOUTH SOUND CARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 LILLY RD NE BLDG 2
OLYMPIA WA
98506-5255
US

IV. Provider business mailing address

520 LILLY RD NE BLDG 2
OLYMPIA WA
98506-5255
US

V. Phone/Fax

Practice location:
  • Phone: 564-250-4200
  • Fax: 360-353-4148
Mailing address:
  • Phone: 564-250-4200
  • Fax: 360-353-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TREVOR STANTUS
Title or Position: OWNER
Credential:
Phone: 564-250-4200