Provider Demographics
NPI:1134549421
Name:FRED & DEBBIE INC
Entity type:Organization
Organization Name:FRED & DEBBIE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-671-8388
Mailing Address - Street 1:4213 RURAL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9231
Mailing Address - Country:US
Mailing Address - Phone:360-671-8388
Mailing Address - Fax:360-671-9012
Practice Address - Street 1:4213 RURAL AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9231
Practice Address - Country:US
Practice Address - Phone:360-671-8388
Practice Address - Fax:360-671-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000462251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health