Healthcare Provider Details

I. General information

NPI: 1164547626
Provider Name (Legal Business Name): RAINIER STATE SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 RYAN RD
BUCKLEY WA
98321-9115
US

IV. Provider business mailing address

2120 RYAN RD
BUCKLEY WA
98321-9115
US

V. Phone/Fax

Practice location:
  • Phone: 360-829-1111
  • Fax: 360-829-3088
Mailing address:
  • Phone: 360-829-1111
  • Fax: 360-829-3088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN T PECK
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 425-301-9856