Provider Demographics
NPI:1659761328
Name:ANN JUDITH IN HOME CAREGIVERS OF WESTERN WASHINGTON
Entity Type:Organization
Organization Name:ANN JUDITH IN HOME CAREGIVERS OF WESTERN WASHINGTON
Other - Org Name:HOMEWATCH CAREGIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIESZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-778-1288
Mailing Address - Street 1:6912 220TH ST SW
Mailing Address - Street 2:SUITE #107
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2169
Mailing Address - Country:US
Mailing Address - Phone:425-778-1288
Mailing Address - Fax:206-260-3906
Practice Address - Street 1:6912 220TH ST SW
Practice Address - Street 2:SUITE #107
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2169
Practice Address - Country:US
Practice Address - Phone:425-778-1288
Practice Address - Fax:206-260-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000088253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care