1053800417 NPI number — KALISPEL INDIAN COMMUNITY OF THE KALISPEL RESERVATION WASHINGTON

Table of content: (NPI 1053800417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053800417 NPI number — KALISPEL INDIAN COMMUNITY OF THE KALISPEL RESERVATION WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALISPEL INDIAN COMMUNITY OF THE KALISPEL RESERVATION WASHINGTON
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:
Provider Other Organization Name Type Code:
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:
1053800417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 39
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
USK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99180-0039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-447-7299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1981 N LECLERC
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
USK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-447-7299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
509-445-1147

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  26X04 , 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: 26X04 . This is a "WA DEPT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com