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General NPI Number Information
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NPI Number | 1205151388
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Entity Type | Organization
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Legal Business Name | LOWER ELWHA MATERNAL SUPPORT SERVICES
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 243511 W HIGHWAY 101
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City | PORT ANGELES
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State | WA
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Zip | 98363-9472
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Country | US
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Telephone | 360-452-6252
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Fax | 360-452-6274
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Provider Business Mailing Address
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Address Line | 243511 W HIGHWAY 101
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City | PORT ANGELES
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State | WA
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Zip | 98363-9472
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Country | US
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Telephone | 360-452-6252
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Fax | 360-452-6274
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Authorized Official
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Title or Position | MEDICAL & HEALTH DIRECTOR
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Name | FLORENCE PATRICIA MCEACHRANE-GROSS
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Credential | MD
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Telephone | 360-452-6252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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