Provider Demographics
NPI:1578564126
Name:HEARING CARE CENTERS, SW WA INC.
Entity Type:Organization
Organization Name:HEARING CARE CENTERS, SW WA INC.
Other - Org Name:AVADA HEARING CARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:E
Authorized Official - Last Name:PANNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-736-6283
Mailing Address - Street 1:407 S TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-3917
Mailing Address - Country:US
Mailing Address - Phone:360-736-6283
Mailing Address - Fax:360-736-2606
Practice Address - Street 1:407 S TOWER AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3917
Practice Address - Country:US
Practice Address - Phone:360-736-6283
Practice Address - Fax:360-736-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7116999Medicaid
WA9494006Medicaid
WA7116999Medicaid