Provider Demographics
NPI:1902892615
Name:HOQUIAM HEALTHCARE, INC.
Entity Type:Organization
Organization Name:HOQUIAM HEALTHCARE, INC.
Other - Org Name:PACIFIC CARE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:3035 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-3007
Mailing Address - Country:US
Mailing Address - Phone:360-532-7882
Mailing Address - Fax:360-537-7216
Practice Address - Street 1:3035 CHERRY ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3007
Practice Address - Country:US
Practice Address - Phone:360-532-7882
Practice Address - Fax:360-537-7216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1347314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4113965Medicaid
WA505081Medicare Oscar/Certification