Provider Demographics
NPI:1629161641
Name:HIGHLINE MEDICAL CENTER
Entity Type:Organization
Organization Name:HIGHLINE MEDICAL CENTER
Other - Org Name:HIGHLINE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:206-439-9095
Mailing Address - Street 1:PO BOX 48279
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98148-0279
Mailing Address - Country:US
Mailing Address - Phone:206-439-9095
Mailing Address - Fax:206-433-1031
Practice Address - Street 1:16255 SYLVESTER RD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3017
Practice Address - Country:US
Practice Address - Phone:206-439-9095
Practice Address - Fax:206-433-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
WA15318332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9035817Medicaid
WA15318OtherLICENSE
WA9038613OtherMCD DME FOR SUPPLIES
WA9038613OtherMCD DME FOR SUPPLIES