Provider Demographics
NPI:1407858681
Name:BESSIE BURTON SULLIVAN HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:BESSIE BURTON SULLIVAN HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRAINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MBA
Authorized Official - Phone:206-328-7850
Mailing Address - Street 1:1020 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5336
Mailing Address - Country:US
Mailing Address - Phone:206-328-7850
Mailing Address - Fax:206-568-8575
Practice Address - Street 1:2424 156TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3814
Practice Address - Country:US
Practice Address - Phone:425-519-1265
Practice Address - Fax:425-641-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS- 234251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9044389Medicaid
WA507102Medicare Oscar/Certification