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General NPI Number Information
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NPI Number | 1467440602
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF SOCIAL DEPT OF SHS DIV OF INSTNS
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 850 MAPLE ST
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City | MEDICAL LAKE
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State | WA
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Zip | 99022-0800
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Country | US
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Telephone | 509-565-4000
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Fax | 509-565-4705
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Provider Business Mailing Address
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Address Line | PO BOX 800 850 MAPLE ST
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City | MEDICAL LAKE
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State | WA
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Zip | 99022-0800
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Country | US
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Telephone | 509-565-4000
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Fax | 509-565-4705
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Authorized Official
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Title or Position | DIRECTOR, REVENUE CYCLE
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Name | JESSICA HELENE GRAHAM
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Credential |
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Telephone | 509-565-4131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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