Provider Demographics
NPI:1669479119
Name:METHOW VALLEY HOME HEALTH AGENCY
Entity type:Organization
Organization Name:METHOW VALLEY HOME HEALTH AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:509-997-4013
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0066
Mailing Address - Country:US
Mailing Address - Phone:509-997-4013
Mailing Address - Fax:509-997-4005
Practice Address - Street 1:1005 HWY 20 EAST
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-997-4013
Practice Address - Fax:509-997-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA24X013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9162504Medicaid
WA079815001OtherGROUP HEALTH COOP
119292700OtherUS DOL
WAARMRE01091-58655OtherMSC PROVIDER #
WA0012524OtherDEPT. OF LABOR & INDUSTRI
WAGA0008OtherWV MEDICAL CENTER
WA222066222066OtherPREMERA BLUE CROSS
WAG000300017Medicare ID - Type Unspecified