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General NPI Number Information
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NPI Number | 1063913267
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Entity Type | Organization
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Legal Business Name | PROACTIVE HOME CARE, LLC
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 3121 E MADISON ST STE 203B
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City | SEATTLE
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State | WA
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Zip | 98112-4258
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Country | US
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Telephone | 206-926-9551
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Fax | 206-260-7256
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Provider Business Mailing Address
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Address Line | 3121 E MADISON ST STE 203B
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City | SEATTLE
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State | WA
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Zip | 98112-4258
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Country | US
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Telephone | 206-926-9551
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Fax | 206-260-7256
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Authorized Official
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Title or Position | OWNER AND CEO
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Name | MR. ERIC WILLIAM KELLY
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Credential |
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Telephone | 206-926-9551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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