Provider Demographics
NPI:1437495355
Name:PERFORMANCE MODALITIES INC
Entity Type:Organization
Organization Name:PERFORMANCE MODALITIES INC
Other - Org Name:PERFORMANCE HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:LUANA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-569-4601
Mailing Address - Street 1:19625 62ND AVE S
Mailing Address - Street 2:SUITE A101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1103
Mailing Address - Country:US
Mailing Address - Phone:253-852-5612
Mailing Address - Fax:253-852-0427
Practice Address - Street 1:2414 NW MYHRE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7669
Practice Address - Country:US
Practice Address - Phone:360-698-0674
Practice Address - Fax:360-698-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035186Medicaid
WA2035186Medicaid