Provider Demographics
NPI:1891301750
Name:SRC HOMECARE, INC.
Entity Type:Organization
Organization Name:SRC HOMECARE, INC.
Other - Org Name:BRIGHTSTAR CARE OF BELLEVUE & NORTH SEATTLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-777-1190
Mailing Address - Street 1:1102 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5666
Mailing Address - Country:US
Mailing Address - Phone:206-777-1190
Mailing Address - Fax:206-420-3835
Practice Address - Street 1:1102 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5666
Practice Address - Country:US
Practice Address - Phone:206-777-1190
Practice Address - Fax:206-420-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty