Provider Demographics
NPI:1932487535
Name:SUPPLEMENTAL HEALTHCARE
Entity Type:Organization
Organization Name:SUPPLEMENTAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECRUITING COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-835-8091
Mailing Address - Street 1:1010 S 336TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7354
Mailing Address - Country:US
Mailing Address - Phone:866-835-8091
Mailing Address - Fax:888-835-8091
Practice Address - Street 1:1010 S 336TH ST STE 210
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7354
Practice Address - Country:US
Practice Address - Phone:866-835-8091
Practice Address - Fax:888-835-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-30
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160082801251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health