1942388194 NPI number — THE CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGON

Table of content: (NPI 1942388194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942388194 NPI number — THE CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGON
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:
1942388194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARM SPRINGS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97761-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-553-3205
Provider Business Mailing Address Fax Number:
541-553-4900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1115 WASCO ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARM SPRINGS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97761-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-553-3205
Provider Business Practice Location Address Fax Number:
541-553-4900
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STACONA
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY/TREASURER-CEO
Authorized Official Telephone Number:
541-553-3232

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  136064 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 136064 . This is a "TARGETED CASE MANAGEMENT" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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