MEDICARE: BRIGID COLLINS HOUSE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency	601247889	WA

General Provider Information

NPI Number	:	1992029607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGID COLLINS HOUSE

Provider Business Mailing Address
First Line	:	1231 N GARDEN ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-5161
Country	:	US
Telephone Number	:	360-734-4616
Fax Number	:	360-734-1763

Provider Business Practice Location Address
First Line	:	1231 N GARDEN ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-5161
Country	:	US
Telephone Number	:	360-734-4616
Fax Number	:	360-734-1763

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. BYRON G. MANERING
Credential	:	M.S.W.
Telephone Number	:	360-734-4616

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	03/24/2010

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