Healthcare Provider Details

I. General information

NPI: 1326961202
Provider Name (Legal Business Name): OTHELLO SENIOR CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ROSE DR
OTHELLO WA
99344-1867
US

IV. Provider business mailing address

520 ROSE DR
OTHELLO WA
99344-1867
US

V. Phone/Fax

Practice location:
  • Phone: 509-488-9556
  • Fax: 509-488-6081
Mailing address:
  • Phone: 509-488-9556
  • Fax: 509-488-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: DIANA EDITH CASTILLO
Title or Position: ADMINISTRATOR
Credential:
Phone: 509-346-7734