Provider Demographics
NPI:1649647579
Name:HOMEWELL SENIOR CARE OF SOUTH KING COUNTY
Entity type:Organization
Organization Name:HOMEWELL SENIOR CARE OF SOUTH KING COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-709-9290
Mailing Address - Street 1:200 S 333RD ST STE 140
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6377
Mailing Address - Country:US
Mailing Address - Phone:253-333-1906
Mailing Address - Fax:253-333-0664
Practice Address - Street 1:200 S 333RD ST STE 140
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6377
Practice Address - Country:US
Practice Address - Phone:253-333-1906
Practice Address - Fax:253-333-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000092253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care