Provider Demographics
NPI:1114336237
Name:PROVIDENCE HUMAN SERVICES OF WA
Entity Type:Organization
Organization Name:PROVIDENCE HUMAN SERVICES OF WA
Other - Org Name:ACES COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-619-0190
Mailing Address - Street 1:1700 E SCHNEIDMILLER AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7085
Mailing Address - Country:US
Mailing Address - Phone:208-619-0190
Mailing Address - Fax:208-619-0195
Practice Address - Street 1:1700 E SCHNEIDMILLER AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7085
Practice Address - Country:US
Practice Address - Phone:208-619-0190
Practice Address - Fax:208-619-0195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PROVIDENCE SERVICE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health