1710283619 NPI number — YAKIMA VALLEY COUNCIL ON ALCOHOLISM

Table of content: (NPI 1710283619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710283619 NPI number — YAKIMA VALLEY COUNCIL ON ALCOHOLISM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAKIMA VALLEY COUNCIL ON ALCOHOLISM
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:
1710283619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2849
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:
98907-2849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-248-1800
Provider Business Mailing Address Fax Number:
509-576-3076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 SUPERIOR LANE
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:
98902-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-853-4175
Provider Business Practice Location Address Fax Number:
509-576-3050
Provider Enumeration Date:
02/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SEDA
Authorized Official First Name:
JOLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
509-853-4121

Provider Taxonomy Codes

  • Taxonomy code: 261QM3000X , with the licence number:  600393849 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 600393849 , 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: 152200 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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