Provider Demographics
NPI:1902159098
Name:CAREGIVERS HOME HEALTH
Entity Type:Organization
Organization Name:CAREGIVERS HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-457-1644
Mailing Address - Street 1:PO BOX 3157
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0341
Mailing Address - Country:US
Mailing Address - Phone:360-457-1644
Mailing Address - Fax:360-457-7186
Practice Address - Street 1:3228 E HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-9073
Practice Address - Country:US
Practice Address - Phone:360-457-1644
Practice Address - Fax:360-457-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000244251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA091936Medicaid
WA810134Medicaid