1952474405 NPI number — NORTH EAST WASHINGTON TREATMENT ALTERNATIVES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952474405 NPI number — NORTH EAST WASHINGTON TREATMENT ALTERNATIVES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH EAST WASHINGTON TREATMENT ALTERNATIVES
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:
NEWTA
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:
1952474405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1224 N ASH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-326-7740
Provider Business Mailing Address Fax Number:
509-326-6725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 N ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-326-7740
Provider Business Practice Location Address Fax Number:
509-326-6725
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DRIGGS
Authorized Official First Name:
LORENZO
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
509-326-7740

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  32 0268 00 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 264 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 32 0268 00 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1992254 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".