Healthcare Provider Details

I. General information

NPI: 1285064428
Provider Name (Legal Business Name): COMPREHENSIVE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 08/12/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 KELLY PL SUITE 235
WALLA WALLA WA
99362
US

IV. Provider business mailing address

PO BOX 959
YAKIMA WA
98907-0959
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-4000
  • Fax:
Mailing address:
  • Phone: 509-575-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number015
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JODI DALY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 509-575-4084