Healthcare Provider Details

I. General information

NPI: 1558689711
Provider Name (Legal Business Name): OLYMPIC COMMUNITY ACTION PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 W 1ST ST STE J
PORT ANGELES WA
98362-2639
US

IV. Provider business mailing address

228 W 1ST ST STE J
PORT ANGELES WA
98362-2639
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-4726
  • Fax: 360-457-4331
Mailing address:
  • Phone: 360-452-4726
  • Fax: 360-457-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number600-443-619
License Number StateWA

VIII. Authorized Official

Name: MRS. SHEILA R RAND
Title or Position: OLYCAP MEDICAID BILLING SPECIALIST
Credential:
Phone: 360-452-4726