Healthcare Provider Details

I. General information

NPI: 1285677336
Provider Name (Legal Business Name): YAKIMA HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S 9TH AVE
YAKIMA WA
98902-3315
US

IV. Provider business mailing address

110 S 9TH AVE
YAKIMA WA
98902-3315
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-5102
  • Fax:
Mailing address:
  • Phone: 509-575-5102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 615-465-7466