Basic Information
| Provider Information | |||||||||
| NPI: | 1740379973 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TOUCHMARK ON SOUTH HILL LP | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | TOUCHMARK ON SOUTH HILL HOME HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5150 SW GRIFFITH DR | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970052935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036465186 | ||||||||
| FaxNumber: | 5036443568 | ||||||||
| Practice Location | |||||||||
| Address1: | 2929 S WATERFORD DR | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992034400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095362929 | ||||||||
| FaxNumber: | 5095363999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 05/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | PRYOR | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | EUGENE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5036465186 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | IS-071 | WA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | IHS.FS.00000071 | 01 | WA | STATE OF WA LICENSE | OTHER |