Organization Name: | KALISPEL INDIAN COMMUNITY OF THE KALISPEL RESERVATION WASHINGTON |
NPI Number: | 1396937769 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LORA JASMAN (DIRECTOR OF MEDICAL SERVICES) |
Mailing Address: | 1821 Leclerc Rd N Cusick |
State: | WA US |
Postal Code: | 991199682 |
Phone Number: | 5094477111 |
Fax Number: | |
NPI Enumeration Date: | 08/09/2007 |
NPI Last Update Date: | 12/26/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QH0100X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Health Service |
Taxonomy Definition: |