Provider Demographics
NPI:1073370045
Name:DEPARTMENT OF SOCIAL AND HEALTH SERVICE
Entity Type:Organization
Organization Name:DEPARTMENT OF SOCIAL AND HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NGRI QUALITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:UMBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:253-993-0557
Mailing Address - Street 1:20311 OLD HIGHWAY 9 SW
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20311 OLD HIGHWAY 9 SW
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531
Practice Address - Country:US
Practice Address - Phone:564-464-5439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness