Provider Demographics
NPI:1487042552
Name:OLYMPIC SENIOR CARE, LLC
Entity Type:Organization
Organization Name:OLYMPIC SENIOR CARE, LLC
Other - Org Name:HOME INSTEAD SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KEMP
Authorized Official - Last Name:BOUGHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-681-2511
Mailing Address - Street 1:675 N 5TH AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3066
Mailing Address - Country:US
Mailing Address - Phone:360-681-2511
Mailing Address - Fax:360-681-0350
Practice Address - Street 1:675 N 5TH AVE STE 1B
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3066
Practice Address - Country:US
Practice Address - Phone:360-681-2511
Practice Address - Fax:360-681-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000147253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care