MEDICARE: STILLAGUAMISH TRIBE OF INDIANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	261QM2800X	Methadone Clinic
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790826600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILLAGUAMISH TRIBE OF INDIANS

Provider Business Mailing Address
First Line	:	5700 172ND ST NE # A
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-7742
Country	:	US
Telephone Number	:	360-652-9640
Fax Number	:	360-652-2093

Provider Business Practice Location Address
First Line	:	5700 172ND ST NE # A
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-7742
Country	:	US
Telephone Number	:	360-652-9640
Fax Number	:	360-652-2093

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	KRISTA YANDLE
Credential	:
Telephone Number	:	360-652-9640

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	05/08/2025

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