Madrona Peak LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

MADRONA PEAK LLC

Doing business as

Generations Home Care

Practice address

6430 Tacoma Mall Blvd Ste 201
Tacoma, WA 98409-6700

Phone

(253) 693-4092

Fax

(253) 204-3568

NPI assigned

Jul 21, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacob T Gamble

Title

Member

Phone

(509) 251-3016

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Generations Home Care Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1528793643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6430 TACOMA MALL BLVD STE 201",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984096700",
            "telephone_number": "253-693-4092",
            "fax_number": "253-204-3568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6430 TACOMA MALL BLVD STE 201",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984096700",
            "telephone_number": "253-693-4092",
            "fax_number": "253-204-3568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 W Maxwell Ave Ste 3",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992012462",
            "country_code": "US",
            "telephone_number": "509-824-2780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MADRONA PEAK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-21",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "509-251-3016"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH",
            "identifier": "IHS.FS.60603640",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Generations Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• In Home Supportive Care Agency in Tacoma, WA
• Providers in Tacoma, WA by specialty
• In Home Supportive Care Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.