1891898953 NPI number — THE EMMAUS CENTER

Table of content: (NPI 1891898953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891898953 NPI number — THE EMMAUS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE EMMAUS CENTER
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:
EMMAUS COUNSELING CENTER
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:
1891898953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1428
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352-1428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-946-1430
Provider Business Mailing Address Fax Number:
509-946-1432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1124 STEVENS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99354-3360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-946-1430
Provider Business Practice Location Address Fax Number:
509-946-1432
Provider Enumeration Date:
09/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OLSON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
509-946-1430

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7880206 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".