Healthcare Provider Details

I. General information

NPI: 1649580713
Provider Name (Legal Business Name): THE HEALING LODGE OF THE SEVEN NATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
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 Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberRTF-1023
License Number StateWA

VIII. Authorized Official

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