Healthcare Provider Details

I. General information

NPI: 1487246716
Provider Name (Legal Business Name): MCCOLLUM HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 THE PKWY
RICHLAND WA
99352-4233
US

IV. Provider business mailing address

616 THE PKWY
RICHLAND WA
99352-4233
US

V. Phone/Fax

Practice location:
  • Phone: 509-380-8479
  • Fax: 509-413-0845
Mailing address:
  • Phone: 509-380-8479
  • Fax: 509-413-0845

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 Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. MANDY L MCCOLLUM
Title or Position: OWNER
Credential: RN
Phone: 509-380-8479