=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770213191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2022
-----------------------------------------------------
Last Update Date | 06/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4616 MLK JR WAY S APT 316
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98108-2160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-371-2399
-----------------------------------------------------
Fax | 206-397-3708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14200 TUKWILA INTERNATIONAL BLVD STE 111
-----------------------------------------------------
City | TUKWILA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98168-4228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-371-2399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SULDAN A MOHAMED
-----------------------------------------------------
Credential | SULDAN MOHAMED
-----------------------------------------------------
Telephone | 206-371-2399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------