Provider Demographics
NPI:1578584892
Name:FAMILY HOME CARE CORPORATION
Entity Type:Organization
Organization Name:FAMILY HOME CARE CORPORATION
Other - Org Name:FAMILY HOME CARE AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-473-4900
Mailing Address - Street 1:22820 E APPLEWAY AVE
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 1:1610 NE EASTGATE BLVD
Practice Address - Street 2:#850
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5625
Practice Address - Country:US
Practice Address - Phone:509-473-4900
Practice Address - Fax:509-755-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS472251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
501534Medicare ID - Type Unspecified