Healthcare Provider Details

I. General information

NPI: 1871820118
Provider Name (Legal Business Name): UNION GOSPEL MISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 W MALLON AVE
SPOKANE WA
99201-1553
US

IV. Provider business mailing address

2828 WEST MALLON AVE.
SPOKANE WA
99201
US

V. Phone/Fax

Practice location:
  • Phone: 509-327-7737
  • Fax:
Mailing address:
  • Phone: 509-327-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number50D1044434
License Number StateWA

VIII. Authorized Official

Name: MR. DEAN BITZ
Title or Position: ACCOUNTANT
Credential:
Phone: 509-535-8510