1619560471 NPI number — EH HEALTH HOME HEALTH OF THE NORTHWEST, LLC

Table of content: (NPI 1619560471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619560471 NPI number — EH HEALTH HOME HEALTH OF THE NORTHWEST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EH HEALTH HOME HEALTH OF THE NORTHWEST, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ENHABIT HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619560471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6688 N CENTRAL EXPY STE 1300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-3950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-239-6500
Provider Business Mailing Address Fax Number:
214-239-6581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
907 N POPLAR ST STE 277
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-1345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-234-6684
Provider Business Practice Location Address Fax Number:
307-234-6066
Provider Enumeration Date:
02/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CARLISLE
Authorized Official First Name:
CRISSY
Authorized Official Middle Name:
BUCHANAN
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
214-239-6500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com