Provider Demographics
NPI:1841581691
Name:COLUMBIA BASIN COMPANION CARE, LLC
Entity Type:Organization
Organization Name:COLUMBIA BASIN COMPANION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT CARE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:509-392-1045
Mailing Address - Street 1:32 S BERMUDA RD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-8300
Mailing Address - Country:US
Mailing Address - Phone:509-392-1045
Mailing Address - Fax:509-628-1293
Practice Address - Street 1:8220 W GAGE BLVD # 124
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8113
Practice Address - Country:US
Practice Address - Phone:509-392-1045
Practice Address - Fax:509-628-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.60210599253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care