NPIMap

Organization Active NPI

Providence Health & Services

Doing business as d/b/a/ Providence DominiCare

  • In Home Supportive Care Agency
  • Chewelah, WA
National Provider Identifier
1609322528
Registry record updated Aug 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
IHS.FS.60259664 Issued in WA
Legal business name
PROVIDENCE HEALTH & SERVICES
Doing business as
d/b/a/ Providence DominiCare
Practice address
110 S. Third Street E.
Chewelah, WA 99109
Phone
(509) 935-4925
Fax
(509) 935-4082
NPI assigned
Aug 31, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2016

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

Authorized official

Name
Ms. Joan Elizabeth Sisco
Title
Director
Phone
(509) 935-4925

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X IHS.FS.60259664 WA Primary

Addresses

Primary practice location

110 S. Third Street E.
Chewelah, WA 99109

Mailing address

PO Box 1070
Chewelah, WA 99109-1070
Phone (509) 935-4925

Other names 1

  • d/b/a/ Providence DominiCare Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472601600000",
    "number": "1609322528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1070",
            "city": "CHEWELAH",
            "state": "WA",
            "postal_code": "991091070",
            "telephone_number": "509-935-4925",
            "fax_number": "509-935-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S. THIRD STREET E.",
            "city": "CHEWELAH",
            "state": "WA",
            "postal_code": "99109",
            "telephone_number": "509-935-4925",
            "fax_number": "509-935-4082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-31",
        "last_updated": "2016-08-31",
        "status": "A",
        "authorized_official_last_name": "SISCO",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "509-935-4925",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "WA",
            "license": "IHS.FS.60259664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d/b/a/ Providence DominiCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chewelah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; 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.