1801129754 NPI number — STILLAGUAMISH TRIBE OF INDIANS

Table of content: (NPI 1801129754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801129754 NPI number — STILLAGUAMISH TRIBE OF INDIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STILLAGUAMISH TRIBE OF INDIANS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ISLAND CROSSING COUNSELING SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801129754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21123 SMOKEY POINT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98223-4224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-652-9640
Provider Business Mailing Address Fax Number:
360-652-2093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21123 SMOKEY POINT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-652-9640
Provider Business Practice Location Address Fax Number:
360-652-2093
Provider Enumeration Date:
09/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KEPLINGER
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
TREATMENT DIRECTOR
Authorized Official Telephone Number:
360-652-9640

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1994565 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com