Provider Demographics
NPI:1770503211
Name:WASHINGTON HEALTHCARE
Entity Type:Organization
Organization Name:WASHINGTON HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-241-1452
Mailing Address - Street 1:1162 INDUSTRY DR
Mailing Address - Street 2:BUILDING 42
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-4803
Mailing Address - Country:US
Mailing Address - Phone:206-243-6664
Mailing Address - Fax:206-241-4483
Practice Address - Street 1:1162 INDUSTRY DR
Practice Address - Street 2:BUILDING 42
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-4803
Practice Address - Country:US
Practice Address - Phone:206-243-6664
Practice Address - Fax:206-241-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA06-2083332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9057662Medicaid
WA9057662Medicaid