Healthcare Provider Details

I. General information

NPI: 1144600313
Provider Name (Legal Business Name): TRI-CITIES CHAPLAINCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 FOWLER ST
RICHLAND WA
99352-4717
US

IV. Provider business mailing address

1480 FOWLER ST
RICHLAND WA
99352-4717
US

V. Phone/Fax

Practice location:
  • Phone: 509-783-7416
  • Fax: 509-735-7850
Mailing address:
  • Phone: 509-783-7416
  • Fax: 509-735-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number601128829
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number601128829
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number601128829
License Number StateWA

VIII. Authorized Official

Name: GARY CASTILLO
Title or Position: ACTING EXECUTIVE DIRECTOR
Credential:
Phone: 509-783-7416