Provider Demographics
NPI:1013767383
Name:PACIFIC WELLNESS HOME VISIT LLC
Entity Type:Organization
Organization Name:PACIFIC WELLNESS HOME VISIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP,ARNP
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARE
Authorized Official - Middle Name:MELAK
Authorized Official - Last Name:KASSAHUN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-458-5983
Mailing Address - Street 1:108 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2971
Mailing Address - Country:US
Mailing Address - Phone:206-458-5983
Mailing Address - Fax:
Practice Address - Street 1:108 UNION AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2971
Practice Address - Country:US
Practice Address - Phone:206-458-5983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health