Provider Demographics
NPI:1518482215
Name:GLACIER PEAK HEALTHCARE, INC.
Entity Type:Organization
Organization Name:GLACIER PEAK HEALTHCARE, INC.
Other - Org Name:ALPHA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:10530 19TH AVE SE STE 201
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4282
Mailing Address - Country:US
Mailing Address - Phone:425-357-1790
Mailing Address - Fax:
Practice Address - Street 1:10530 19TH AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4282
Practice Address - Country:US
Practice Address - Phone:425-357-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health