1912060393 NPI number — FAMILY SERVICE OF THE TRI-CITIES

Table of content: MARY COLLEEN DAVERN HIPSKIND (NPI 1003400631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912060393 NPI number — FAMILY SERVICE OF THE TRI-CITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICE OF THE TRI-CITIES
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:
1912060393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39899 BALENTINE DR
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94560-5355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-791-3322
Provider Business Mailing Address Fax Number:
510-791-3325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39899 BALENTINE DR
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94560-5355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-791-3322
Provider Business Practice Location Address Fax Number:
510-791-3325
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THERIAULT
Authorized Official First Name:
INGRID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
510-791-3322

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com