Provider Demographics
NPI:1821433558
Name:PERFORMANCE MODALITIES INC
Entity Type:Organization
Organization Name:PERFORMANCE MODALITIES INC
Other - Org Name:PERFORMANCE HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANGER OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:LUANA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-569-4601
Mailing Address - Street 1:19625 62ND AVE S STE A101
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1106
Mailing Address - Country:US
Mailing Address - Phone:253-852-5612
Mailing Address - Fax:253-852-0427
Practice Address - Street 1:3202 COLBY AVE STE D
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4324
Practice Address - Country:US
Practice Address - Phone:425-252-6932
Practice Address - Fax:425-252-6933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANONE REQUIRED332B00000X
WANOT REQUIRED332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20351485Medicaid
WA20351485Medicaid