Organization Name: | SQUAXIN ISLAND TRIBE |
NPI Number: | 1023226685 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EDWARD J FOX (HHS DIRECTOR) |
Mailing Address: | 90 Se Klah Che Min Drive Shelton |
State: | WA US |
Postal Code: | 98584 |
Phone Number: | 3604279006 |
Fax Number: | 3604271951 |
NPI Enumeration Date: | 05/18/2007 |
NPI Last Update Date: | 07/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | 600371470 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |