Provider Demographics
NPI:1629288618
Name:CAREAGE HOME HEALTH LLC
Entity Type:Organization
Organization Name:CAREAGE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-853-4457
Mailing Address - Street 1:PO BOX 1969
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3969
Mailing Address - Country:US
Mailing Address - Phone:253-853-4457
Mailing Address - Fax:253-853-5280
Practice Address - Street 1:14450 NE 29TH PL
Practice Address - Street 2:SUITE 106
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-8616
Practice Address - Country:US
Practice Address - Phone:425-519-1265
Practice Address - Fax:425-861-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.60007888251E00000X
261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA507102Medicare Oscar/Certification