MEDICARE: FAMILY HOME CARE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	IS281	WA
2	251E00000X	Home Health Agency	IS280	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	147269	OTHER	WA	LABOR & INDUSTRIES
2	5090FA	OTHER	WA	REGENCE PVT INSURANCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1128	OTHER	WA	PREMERA PVT INSURANCE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275536757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HOME CARE CORPORATION

Provider Business Mailing Address
First Line	:	22820 E APPLEWAY
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-9514
Country	:	US
Telephone Number	:	509-473-4900
Fax Number	:	509-755-4974

Provider Business Practice Location Address
First Line	:	22820 E APPLEWAY
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-9514
Country	:	US
Telephone Number	:	509-473-4900
Fax Number	:	509-755-4974

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. JEFFREY R KOLCUM
Credential	:	CPA
Telephone Number	:	509-473-4900

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	01/19/2009

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1578635405 — JEAN M ROHRER CRNP MSN
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1154566545 — MRS. AMY KAREN SCHAFFNER FNP-BC
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1679554935 — MS. AMY JEANETTE TREVINO MPT
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1558300194 — GREG A HARADA DPT
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Directions to “FAMILY HOME CARE CORPORATION ” Practice Location

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