Provider Demographics
NPI:1265476881
Name:PUGET SOUND HOME HEALTH LLC
Entity Type:Organization
Organization Name:PUGET SOUND HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-581-9410
Mailing Address - Street 1:7714 BRIDGEPORT WAY W
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8380
Mailing Address - Country:US
Mailing Address - Phone:253-581-9410
Mailing Address - Fax:253-581-9207
Practice Address - Street 1:7714 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8380
Practice Address - Country:US
Practice Address - Phone:253-581-9410
Practice Address - Fax:253-581-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS424251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9039918Medicaid
WA507101Medicare PIN