Provider Demographics
NPI:1720220908
Name:WASHINGTON HOMECARE AND HOSPICE OF CENTRAL BASIN, LLC
Entity Type:Organization
Organization Name:WASHINGTON HOMECARE AND HOSPICE OF CENTRAL BASIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:INDEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:420 W PINHOOK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2131
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-233-5764
Practice Address - Street 1:311 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1905
Practice Address - Country:US
Practice Address - Phone:509-765-1856
Practice Address - Fax:509-765-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA507048Medicare Oscar/Certification