Provider Demographics
NPI:1386238939
Name:CARE IN HOME LLC
Entity type:Organization
Organization Name:CARE IN HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUS
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERKOLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-549-3100
Mailing Address - Street 1:909 SE EVERETT MALL WAY STE C302
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3745
Mailing Address - Country:US
Mailing Address - Phone:425-549-3100
Mailing Address - Fax:425-458-2366
Practice Address - Street 1:909 SE EVERETT MALL WAY STE C302
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3745
Practice Address - Country:US
Practice Address - Phone:425-549-3100
Practice Address - Fax:425-458-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2168537Medicaid