| NPI | 1326123670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONI LODGE Executive Director 509-325-5502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: WA 601182805) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 1041C0700X Social Worker, Clinical | |
| 133V00000X Dietitian, Registered | |
| 163W00000X Registered Nurse | |
| 163WD0400X Registered Nurse, Diabetes Educator (Licence: WA RN00122081) | |
| 207Q00000X Family Medicine | |
| 291U00000X Clinical Medical Laboratory (Licence: WA 50D0968048) | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2014-12-05 |