1548384126 NPI number — TSAPOWUM-CHEHALIS TRIBAL CHEMICAL DEPENDANCY

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 1548384126 NPI number — TSAPOWUM-CHEHALIS TRIBAL CHEMICAL DEPENDANCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TSAPOWUM-CHEHALIS TRIBAL CHEMICAL DEPENDANCY
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:
1548384126
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 570
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98568-0570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-858-1660
Provider Business Mailing Address Fax Number:
360-273-2723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 HOWANUT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-858-1660
Provider Business Practice Location Address Fax Number:
360-273-2723
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POCKAT
Authorized Official First Name:
MARSHA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
BILLING COORDINATOR
Authorized Official Telephone Number:
360-858-1660

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  14 0096 00 , 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: 14 0096 00 . This is a "ADATSA APPROVAL NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1992684 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com