| Illahee Home Corp | |
|
1155 N State St Bellingham WA 98225-5037 | |
| (360) 676-4485 | |
| (360) 714-1294 |
| Full Name | Illahee Home Corp |
|---|---|
| Speciality | Counselor |
| Location | 1155 N State St, Bellingham, Washington |
| Authorized Official Name and Position | Kelly Frost (PRESIDENT) |
| Authorized Official Contact | 3606764485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illahee Home Corp 1155 N State St Bellingham WA 98225-5037 Ph: (360) 676-4485 | Illahee Home Corp 1155 N State St Bellingham WA 98225-5037 Ph: (360) 676-4485 |
| NPI Number | 1124329669 |
|---|---|
| Provider Enumeration Date | 11/16/2010 |
| Last Update Date | 01/07/2025 |
| Certification Date | 01/07/2025 |
| Medicare PECOS PAC ID | 7719374776 |
|---|---|
| Medicare Enrollment ID | O20220422000673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124329669 | NPI | - | NPPES |
| 2200984 | Medicaid | WA |
| Provider Name | Tracee Ferol Mullen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740693092 PECOS PAC ID: 1850815341 Enrollment ID: I20250407000393 |
| Provider Name | Kelly Frost |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245788694 PECOS PAC ID: 0941723076 Enrollment ID: I20250408003367 |
| Provider Name | Gurpal Singh Chahal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306482831 PECOS PAC ID: 4880118124 Enrollment ID: I20250408003662 |
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