Healthcare Provider Details

I. General information

NPI: 1538450911
Provider Name (Legal Business Name): LARCH CORRECTIONS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15314 NE DOLE VALLEY RD
YACOLT WA
98675-9521
US

IV. Provider business mailing address

PO BOX 41107
OLYMPIA WA
98504-1107
US

V. Phone/Fax

Practice location:
  • Phone: 360-260-6300
  • Fax: 360-686-3966
Mailing address:
  • Phone: 360-725-8298
  • Fax: 360-586-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOUIS MCDERMOTT
Title or Position: HEALTHCARE FINANCE MANAGER
Credential:
Phone: 360-725-8301