Healthcare Provider Details

I. General information

NPI: 1083009492
Provider Name (Legal Business Name): THE HEALING LODGE OF THE SEVEN NATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 E 8TH AVE
SPOKANE VALLEY WA
99212-0220
US

IV. Provider business mailing address

5600 E 8TH AVE
SPOKANE VALLEY WA
99212-0220
US

V. Phone/Fax

Practice location:
  • Phone: 509-533-6910
  • Fax: 509-535-2863
Mailing address:
  • Phone: 509-533-6910
  • Fax: 509-535-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES R WALDE
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 509-533-6910