Provider Demographics
NPI:1356708895
Name:VANCOUVER HOME HEALTH CARE AGENCY LLC
Entity type:Organization
Organization Name:VANCOUVER HOME HEALTH CARE AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYON
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-975-7070
Mailing Address - Street 1:201 NE PARK PLAZA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5871
Mailing Address - Country:US
Mailing Address - Phone:360-975-7070
Mailing Address - Fax:360-975-4306
Practice Address - Street 1:201 NE PARK PLAZA DR STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5871
Practice Address - Country:US
Practice Address - Phone:360-975-7070
Practice Address - Fax:800-605-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1356708895OtherHOME HEALTH
WA1356708895OtherHOME HEALTH