Provider Demographics
NPI:1083009492
Name:THE HEALING LODGE OF THE SEVEN NATIONS
Entity Type:Organization
Organization Name:THE HEALING LODGE OF THE SEVEN NATIONS
Other - Org Name:FAMILY AND WELLNESS HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-533-6910
Mailing Address - Street 1:5600 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0220
Mailing Address - Country:US
Mailing Address - Phone:509-533-6910
Mailing Address - Fax:509-535-2863
Practice Address - Street 1:5600 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-0220
Practice Address - Country:US
Practice Address - Phone:509-533-6910
Practice Address - Fax:509-535-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health