Caritas Critical Case Management, LLC

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

License

4219311 Issued in NJ

Legal business name

CARITAS CRITICAL CASE MANAGEMENT, LLC

Practice address

23205 SE Black Nugget Rd
Apt J2
Issaquah, WA 98029-7326

Phone

(206) 207-9363

NPI assigned

Apr 24, 2017

Last updated

Apr 24, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ebony Blackmom-Humphrey, RN, CCM

Title

Registered Nurse

Phone

(206) 207-9363

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ebony Blackmon Humphrey, DNP ARNP PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Issaquah, WA
  • NPI 1669904108

  Registered Nurse

  NPD (past)

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

{
    "created_epoch": "1492992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492992000000",
    "number": "1659806032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23205 SE BLACK NUGGET RD",
            "address_2": "APT J2",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980297326",
            "telephone_number": "206-207-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23205 SE BLACK NUGGET RD",
            "address_2": "APT J2",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980297326",
            "telephone_number": "206-207-9363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARITAS CRITICAL CASE MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-24",
        "last_updated": "2017-04-24",
        "status": "A",
        "authorized_official_last_name": "BLACKMOM-HUMPHREY",
        "authorized_official_first_name": "EBONY",
        "authorized_official_title_or_position": "REGISTERED NURSE",
        "authorized_official_telephone_number": "206-207-9363",
        "authorized_official_credential": "RN, CCM"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60625891",
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "NJ",
            "license": "4219311",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "WA",
            "license": "RN60625891",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Case Management Registered Nurse in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Case Management Registered Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; 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.