Provider Demographics
NPI:1497951651
Name:FAMILY HOME CARE CORPORATION
Entity Type:Organization
Organization Name:FAMILY HOME CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-755-4904
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:509-755-4987
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:509-755-4987
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HOME CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-25
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS280251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA783884Medicaid
WA9052200Medicaid
WA9050949Medicaid
WA0147269OtherL&I
WA7330095Medicaid
WA9055120Medicaid
WA23173OtherGROUP HEALTH
WA1128OtherPREMERA BLUE CROSS
WA7408065Medicaid
WAG8860983Medicare PIN
WA9050949Medicaid
WA4356670001Medicare ID - Type UnspecifiedNORIDIAN DMERC
WA783884Medicaid