1437204369 NPI number — THE HEALING LODGE OF THE SEVEN NATIONS

Table of content: (NPI 1437204369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437204369 NPI number — THE HEALING LODGE OF THE SEVEN NATIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEALING LODGE OF THE SEVEN NATIONS
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:
THE HEALING LODGE - BUTTERFLY PELPALWICHIYA GIRLS CD
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:
1437204369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 E 8TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99212-0220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-533-6910
Provider Business Mailing Address Fax Number:
509-535-2863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 E 8TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99212-0220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-533-6910
Provider Business Practice Location Address Fax Number:
509-535-2863
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALDE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
FINANCIAL DIRECTOR
Authorized Official Telephone Number:
509-533-6910

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  RTF-1023 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3245S0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32150500 . This is a "DSHS/DBHR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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