Healthcare Provider Details

I. General information

NPI: 1265588537
Provider Name (Legal Business Name): SAUK-SUIATTLE INDIAN TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 CHIEF BROWN LN
DARRINGTON WA
98241-9420
US

IV. Provider business mailing address

5318 CHIEF BROWN LN
DARRINGTON WA
98241-9420
US

V. Phone/Fax

Practice location:
  • Phone: 360-436-1400
  • Fax: 360-436-0242
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: RYAN KIPPES
Title or Position: HEALTH & SOCIAL SERVICES DIRECTOR
Credential:
Phone: 360-436-0131