1669918876 NPI number — CASCADE HEALTH SERVICES PLLC

Table of content: (NPI 1669918876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669918876 NPI number — CASCADE HEALTH SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE HEALTH SERVICES PLLC
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:
1669918876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 KALA SQUARE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT TOWNSEND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98368-9804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-344-8166
Provider Business Mailing Address Fax Number:
360-379-6518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 KALA SQUARE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT TOWNSEND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98368-9804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-344-8166
Provider Business Practice Location Address Fax Number:
360-379-6518
Provider Enumeration Date:
01/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FOUNTAIN
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC OPERATIONS MANAGER
Authorized Official Telephone Number:
360-344-8166

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , 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: 2045741 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com