Provider Demographics
NPI:1144600313
Name:TRI-CITIES CHAPLAINCY
Entity Type:Organization
Organization Name:TRI-CITIES CHAPLAINCY
Other - Org Name:TRI-CITIES CHAPLAINCY SUPPORTIVE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ACTING EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-783-7416
Mailing Address - Street 1:1480 FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4717
Mailing Address - Country:US
Mailing Address - Phone:509-783-7416
Mailing Address - Fax:509-735-7850
Practice Address - Street 1:1480 FOWLER ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4717
Practice Address - Country:US
Practice Address - Phone:509-783-7416
Practice Address - Fax:509-735-7850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-CITIES CHAPLAINCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601128829106H00000X, 207R00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3990124Medicaid
WA3990124Medicaid