Provider Demographics
NPI:1770468290
Name:DISHALLC
Entity type:Organization
Organization Name:DISHALLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDNI
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-386-0080
Mailing Address - Street 1:15908 MERIDIAN AVE S
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5578
Mailing Address - Country:US
Mailing Address - Phone:425-386-0080
Mailing Address - Fax:
Practice Address - Street 1:11400 AIRPORT RD STE 200
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-8711
Practice Address - Country:US
Practice Address - Phone:425-386-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care