Provider Demographics
NPI:1114326014
Name:SPECIAL CARE AGENCY
Entity Type:Organization
Organization Name:SPECIAL CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-333-4114
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-1026
Mailing Address - Country:US
Mailing Address - Phone:425-333-4114
Mailing Address - Fax:425-333-4115
Practice Address - Street 1:4121 MCKINLEY AVENUE
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014
Practice Address - Country:US
Practice Address - Phone:425-333-4114
Practice Address - Fax:425-333-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000074253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care