Provider Demographics
NPI:1154459923
Name:INTERIM HEALTHCARE OF SPOKANE, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF SPOKANE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-456-5665
Mailing Address - Street 1:1625 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-1720
Mailing Address - Country:US
Mailing Address - Phone:509-456-5665
Mailing Address - Fax:509-456-7703
Practice Address - Street 1:1625 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-1720
Practice Address - Country:US
Practice Address - Phone:509-456-5665
Practice Address - Fax:509-456-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS-345251E00000X, 251J00000X
IDHH-145251E00000X, 251J00000X
WAIHS.FS.00000345253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9038282Medicaid