MEDICARE: AGING AND LONG TERM CARE OF EASTERN WASHINGTON

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1902154073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGING AND LONG TERM CARE OF EASTERN WASHINGTON

Provider Business Mailing Address
First Line	:	1313 N ATLANTIC ST STE 3000
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2303
Country	:	US
Telephone Number	:	509-458-2509
Fax Number	:	509-458-2003

Provider Business Practice Location Address
First Line	:	1313 N ATLANTIC ST STE 3000
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2303
Country	:	US
Telephone Number	:	509-458-2509
Fax Number	:	509-458-2003

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LYNN KIMBALL
Credential	:
Telephone Number	:	509-458-2509

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	11/07/2024

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