Provider Demographics
NPI:1043653389
Name:SNOHOMISH IN HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:SNOHOMISH IN HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:TERRENCE
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-799-0424
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:INDEX
Mailing Address - State:WA
Mailing Address - Zip Code:98256-0844
Mailing Address - Country:US
Mailing Address - Phone:360-799-0424
Mailing Address - Fax:360-799-0424
Practice Address - Street 1:51706 SKYKO DR
Practice Address - Street 2:
Practice Address - City:INDEX
Practice Address - State:WA
Practice Address - Zip Code:98256
Practice Address - Country:US
Practice Address - Phone:360-799-0424
Practice Address - Fax:360-799-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care