Provider Demographics
NPI:1114099967
Name:NORTHEAST TRI COUNTY HEALTH DISTRICT
Entity Type:Organization
Organization Name:NORTHEAST TRI COUNTY HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VILLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-684-1301
Mailing Address - Street 1:240 E DOMINION AVE
Mailing Address - Street 2:PO BOX 270
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2732
Mailing Address - Country:US
Mailing Address - Phone:509-684-1301
Mailing Address - Fax:509-684-1002
Practice Address - Street 1:240 E DOMINION AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2732
Practice Address - Country:US
Practice Address - Phone:509-684-1301
Practice Address - Fax:509-684-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7400781Medicaid