Healthcare Provider Details

I. General information

NPI: 1639129695
Provider Name (Legal Business Name): DSHS/DDA/YAKIMA VALLEY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 SPEYERS ROAD
SELAH WA
98942-1050
US

IV. Provider business mailing address

609 SPEYERS ROAD
SELAH WA
98942-1050
US

V. Phone/Fax

Practice location:
  • Phone: 509-698-1300
  • Fax: 509-698-2230
Mailing address:
  • Phone: 509-698-1300
  • Fax: 509-697-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number342007865
License Number StateWA

VIII. Authorized Official

Name: MRS. TAMMY K. WINEGAR
Title or Position: SUPERINTENDENT
Credential: NURSING HOME ADMINIS
Phone: 509-698-1255