Healthcare Provider Details

I. General information

NPI: 1750672572
Provider Name (Legal Business Name): WASHINGTON STATE DEPARTMENT OF CORRECTIONS- CEDAR CREEK CORRECTIONS CE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 09/23/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 BORDEAUX ROAD
LITTLEROCK WA
98556-0037
US

IV. Provider business mailing address

PO BOX 41100, MAIL STOP 41100
OLYMPIA WA
98504-1100
US

V. Phone/Fax

Practice location:
  • Phone: 360-359-4100
  • Fax: 360-664-3586
Mailing address:
  • Phone: 360-725-8213
  • Fax: 360-586-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARYANN CURL
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 509-318-3498