Healthcare Provider Details

I. General information

NPI: 1063407393
Provider Name (Legal Business Name): JOSEPHINE CARING COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 272ND PL NW
STANWOOD WA
98292-7449
US

IV. Provider business mailing address

9901 272ND PL NW
STANWOOD WA
98292-7449
US

V. Phone/Fax

Practice location:
  • Phone: 360-629-2126
  • Fax: 360-629-4543
Mailing address:
  • Phone: 360-629-2126
  • Fax: 360-629-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH143
License Number StateWA

VIII. Authorized Official

Name: TERRY ALLEN ROBERTSON
Title or Position: CEO
Credential:
Phone: 360-629-2126