Provider Demographics
NPI:1063407393
Name:JOSEPHINE CARING COMMUNITY
Entity type:Organization
Organization Name:JOSEPHINE CARING COMMUNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-629-2126
Mailing Address - Street 1:9901 272ND PL NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-7449
Mailing Address - Country:US
Mailing Address - Phone:360-629-2126
Mailing Address - Fax:360-629-4543
Practice Address - Street 1:9901 272ND PL NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-7449
Practice Address - Country:US
Practice Address - Phone:360-629-2126
Practice Address - Fax:360-629-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
WANH143314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4114302Medicaid
WA505465Medicare Oscar/Certification