=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144118803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KALISPEL TRIBE OF INDIANS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2025
-----------------------------------------------------
Last Update Date | 12/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10811 W 6TH AVE
-----------------------------------------------------
City | AIRWAY HEIGHTS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99001-5345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-481-4990
-----------------------------------------------------
Fax | 509-223-4644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1887 WHITNEY MESA DR # 8844
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89014-2069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-481-4990
-----------------------------------------------------
Fax | 509-223-4644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, REVENUE CYCLES MANAGEMENT
-----------------------------------------------------
Name | AMANDA MATTHEWS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-234-6634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------