Healthcare Provider Details

I. General information

NPI: 1144018045
Provider Name (Legal Business Name): IBHTF KENNEWICK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7319 W HOOD PL
KENNEWICK WA
99336-6706
US

IV. Provider business mailing address

95 S TOBIN ST STE 100
RENTON WA
98057-5324
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-0155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHARANPREET GILL
Title or Position: OWNER
Credential:
Phone: 206-326-0155