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General NPI Number Information
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NPI Number | 1902323819
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Entity Type | Organization
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Legal Business Name | MUCKLESHOOT INDIAN TRIBE
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 17500 SE 392ND ST
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City | AUBURN
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State | WA
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Zip | 98092-9705
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Country | US
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Telephone | 253-876-3050
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Fax | 253-876-2974
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Provider Business Mailing Address
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Address Line | 17500 SE 392ND ST
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City | AUBURN
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State | WA
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Zip | 98092-9705
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Country | US
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Telephone | 253-876-3050
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Fax | 253-876-2974
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Authorized Official
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Title or Position | ADMINISTRATIVE MANAGER
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Name | HARMONY ROEBUCK
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Credential |
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Telephone | 253-876-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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