=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932433885
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TONYA'S HOUSE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2009
-----------------------------------------------------
Last Update Date | 09/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 328 SW COURT AVE
-----------------------------------------------------
City | PENDLETON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97801-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-276-2900
-----------------------------------------------------
Fax | 541-429-4410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 328 SW COURT AVE
-----------------------------------------------------
City | PENDLETON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97801-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-276-2900
-----------------------------------------------------
Fax | 541-429-4410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | SONDRA JEAN KERBY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-276-2900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------