Basic Information
| Provider Information | |||||||||
| NPI: | 1851461305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL BASIN HOME HEALTH CARE, INC. | ||||||||
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| OtherOrganizationName: | CENTRAL BASIN HOME HEALTH & HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 W 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | MOSES LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988371905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097651856 | ||||||||
| FaxNumber: | 5097653323 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 W 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | MOSES LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988371905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097651856 | ||||||||
| FaxNumber: | 5097653323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 05/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | LASZLO | ||||||||
| AuthorizedOfficialFirstName: | BETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5097651856 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | IS-249 | WA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0018111 | 01 | WA | LABOR & INDUSTRIES | OTHER | 9408600 | 05 | WA | MEDICAID |