Provider Demographics
NPI:1790106920
Name:CAREGIVERS HOME HEALTH, INC
Entity Type:Organization
Organization Name:CAREGIVERS HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:360-457-1644
Mailing Address - Street 1:PO BOX 3157
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0341
Mailing Address - Country:US
Mailing Address - Phone:360-457-1644
Mailing Address - Fax:360-457-7186
Practice Address - Street 1:3228 E HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-9073
Practice Address - Country:US
Practice Address - Phone:360-457-1644
Practice Address - Fax:360-457-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000244374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00000244Medicaid