=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821496381
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY RESOURCE HOME CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2014
-----------------------------------------------------
Last Update Date | 12/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10700 MERIDIAN AVE N SUITE 215
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-9008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-545-1092
-----------------------------------------------------
Fax | 206-545-1189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10700 MERIDIAN AVE N SUITE 215
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-9008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-545-1092
-----------------------------------------------------
Fax | 206-545-1189
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES/CEO
-----------------------------------------------------
Name | DAVID LAWRENCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-545-1092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | IHS.FS.00000282
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------