=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821686486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LT HOME CARE AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2021
-----------------------------------------------------
Last Update Date | 09/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 555 ANDOVER PARK W STE 200
-----------------------------------------------------
City | TUKWILA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98188-3379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-368-9910
-----------------------------------------------------
Fax | 253-480-6893
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21510 104TH STREET CT E
-----------------------------------------------------
City | BONNEY LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98391-3727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-368-9910
-----------------------------------------------------
Fax | 253-480-6893
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TIRUS GITAO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-368-9910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------