Provider Demographics
NPI:1386161289
Name:CHILDREN' S COUNTRY HOME
Entity type:Organization
Organization Name:CHILDREN' S COUNTRY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:RD,CD
Authorized Official - Phone:425-806-9453
Mailing Address - Street 1:14643 NE 166TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-9013
Mailing Address - Country:US
Mailing Address - Phone:425-806-9453
Mailing Address - Fax:425-485-1527
Practice Address - Street 1:14643 NE 166TH ST
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9013
Practice Address - Country:US
Practice Address - Phone:425-806-9453
Practice Address - Fax:425-485-1527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000253251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health