Healthcare Provider Details

I. General information

NPI: 1609072016
Provider Name (Legal Business Name): COUNCIL ON AGING & HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S MAIN ST
COLFAX WA
99111-1820
US

IV. Provider business mailing address

210 S MAIN ST PO BOX 107
COLFAX WA
99111-1820
US

V. Phone/Fax

Practice location:
  • Phone: 509-394-4611
  • Fax: 509-397-2917
Mailing address:
  • Phone: 509-394-4611
  • Fax: 509-397-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT HALLETT
Title or Position: NUTRITION PROGRAM DIRECTOR
Credential:
Phone: 509-397-4611