Provider Demographics
NPI:1275536757
Name:FAMILY HOME CARE CORPORATION
Entity Type:Organization
Organization Name:FAMILY HOME CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOLCUM
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:509-473-4900
Mailing Address - Street 1:22820 E APPLEWAY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9514
Mailing Address - Country:US
Mailing Address - Phone:509-473-4900
Mailing Address - Fax:509-755-4974
Practice Address - Street 1:22820 E APPLEWAY
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-9514
Practice Address - Country:US
Practice Address - Phone:509-473-4900
Practice Address - Fax:509-755-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS280251E00000X
WAIS281251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA147269OtherLABOR & INDUSTRIES
WA5090FAOtherREGENCE PVT INSURANCE
WA7408065Medicaid
WA9050949Medicaid
WA1128OtherPREMERA PVT INSURANCE
WA7330095Medicaid
WA9055120Medicaid
WA119038Medicaid
WA9052200Medicaid
WA119038Medicaid
WA4356670001Medicare NSC