Healthcare Provider Details

I. General information

NPI: 1508820879
Provider Name (Legal Business Name): NEW HEALTH PROGRAM ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E 3RD AVE
COLVILLE WA
99114-2310
US

IV. Provider business mailing address

PO BOX 808
CHEWELAH WA
99109-0808
US

V. Phone/Fax

Practice location:
  • Phone: 509-684-1440
  • Fax: 509-684-1277
Mailing address:
  • Phone: 509-935-6001
  • Fax: 509-935-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberJ600317870
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DONNA POE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 509-935-6001