Provider Demographics
NPI:1164547626
Name:RAINIER STATE SCHOOL
Entity Type:Organization
Organization Name:RAINIER STATE SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-301-9856
Mailing Address - Street 1:2120 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-9115
Mailing Address - Country:US
Mailing Address - Phone:360-829-1111
Mailing Address - Fax:360-829-3088
Practice Address - Street 1:2120 RYAN RD
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-9115
Practice Address - Country:US
Practice Address - Phone:360-829-1111
Practice Address - Fax:360-829-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities