Provider Demographics
NPI:1588662761
Name:KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2
Entity Type:Organization
Organization Name:KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2
Other - Org Name:EVERGREENHEALTH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MALTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-899-2610
Mailing Address - Street 1:12040 NE 128TH ST
Mailing Address - Street 2:MS #103
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3013
Mailing Address - Country:US
Mailing Address - Phone:425-899-3300
Mailing Address - Fax:425-899-3058
Practice Address - Street 1:11800 NE 128TH ST STE 200
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7211
Practice Address - Country:US
Practice Address - Phone:425-899-3300
Practice Address - Fax:425-899-3058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-12
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA507079251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA507079Medicare Oscar/Certification
WA507079Medicare Oscar/Certification