Provider Demographics
NPI:1811507759
Name:CARING WITH COMPASSION COMMUNITY
Entity type:Organization
Organization Name:CARING WITH COMPASSION COMMUNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONITA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:BOULLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-375-5211
Mailing Address - Street 1:17404 MERIDIAN E STE F127
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6234
Mailing Address - Country:US
Mailing Address - Phone:253-375-5211
Mailing Address - Fax:
Practice Address - Street 1:20113 96TH AVE E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8040
Practice Address - Country:US
Practice Address - Phone:253-375-5211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARING WITH COMPASSION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-05
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2170309Medicaid
WA604527651OtherUNIFIED BUSINESS ID