1275938243 NPI number — WEEPING RIDGE WEST, INC.

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 1275938243 NPI number — WEEPING RIDGE WEST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEEPING RIDGE WEST, INC.
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:
1275938243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12402 OSPREY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NINE MILE FALLS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-989-1843
Provider Business Mailing Address Fax Number:
509-465-1813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2455 WEST BENCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTHELLO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-989-1843
Provider Business Practice Location Address Fax Number:
509-465-1813
Provider Enumeration Date:
11/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
ISRAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
509-989-1843

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  751171 , 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: 273641 . This is a "ADULT FAMILY HOME" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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