1194935213 NPI number — THE ARC OF SOUTHWEST WASHINGTON

Table of content: (NPI 1194935213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194935213 NPI number — THE ARC OF SOUTHWEST WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ARC OF SOUTHWEST 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:
6
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:
1194935213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-254-1562
Provider Business Mailing Address Fax Number:
360-759-4921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E 8TH STREET
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-1562
Provider Business Practice Location Address Fax Number:
360-759-4921
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANGELO
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
360-254-1562

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251V00000X , with the licence number: 601138292 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7104771 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1026234 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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