Healthcare Provider Details

I. General information

NPI: 1114239449
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE DIOCESE OF YAKIMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 VAN GIESEN ST
RICHLAND WA
99354-2746
US

IV. Provider business mailing address

2139 VAN GIESEN ST
RICHLAND WA
99354-2746
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-4645
  • Fax: 509-943-2068
Mailing address:
  • Phone: 509-946-4645
  • Fax: 509-943-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JANET WILDENBORG
Title or Position: BOOKKEEPER
Credential:
Phone: 509-946-4645