Provider Demographics
NPI:1114386539
Name:DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Entity Type:Organization
Organization Name:DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Other - Org Name:WA DSHS VDHS
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-725-2446
Mailing Address - Street 1:PO BOX 45600
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98504-5600
Mailing Address - Country:US
Mailing Address - Phone:360-725-2446
Mailing Address - Fax:360-438-8633
Practice Address - Street 1:4450 10TH AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2842
Practice Address - Country:US
Practice Address - Phone:360-725-2446
Practice Address - Fax:360-438-8633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management