Provider Demographics
NPI:1114393345
Name:JANALAIR LLC
Entity Type:Organization
Organization Name:JANALAIR LLC
Other - Org Name:WESTSIDE PROSTHETICS AND ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO/AM, CPO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:ALAIR
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:360-791-2207
Mailing Address - Street 1:7942 NOBLE VIEW LN NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-9629
Mailing Address - Country:US
Mailing Address - Phone:360-791-2207
Mailing Address - Fax:888-570-2341
Practice Address - Street 1:7942 NOBLE VIEW LN NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-9629
Practice Address - Country:US
Practice Address - Phone:360-791-2207
Practice Address - Fax:888-570-2341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JANALAIR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-11
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1639580103Medicaid
ID1114393345Medicaid
ID1639580103Medicaid
WAOI00000055OtherORTHOTIC LICENSE
WAPS00000056OtherPROSTHETIC LICENSE