1285771204 NPI number — YAKIMA NEIGHBORHOOD HEALTH SERVICES

Table of content: (NPI 1285771204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285771204 NPI number — YAKIMA NEIGHBORHOOD HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAKIMA NEIGHBORHOOD HEALTH SERVICES
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:
MSS/ICM
Provider Other Organization Name Type Code:
5
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:
1285771204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98907-2605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-454-4143
Provider Business Mailing Address Fax Number:
509-454-3651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 S 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98901-3020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-454-4243
Provider Business Practice Location Address Fax Number:
509-454-3651
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAUFF
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRIMARY CARE ADMINISTRATOR
Authorized Official Telephone Number:
509-454-4143

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7404577 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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