Provider Demographics
NPI:1194035261
Name:THE HEALING LODGE OF THE SEVEN NATIONS
Entity Type:Organization
Organization Name:THE HEALING LODGE OF THE SEVEN NATIONS
Other - Org Name:THE HEALING LODGE - SAGE BOYS CD
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-533-6910
Mailing Address - Street 1:5600 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0220
Mailing Address - Country:US
Mailing Address - Phone:509-533-6910
Mailing Address - Fax:509-535-2863
Practice Address - Street 1:5600 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-0220
Practice Address - Country:US
Practice Address - Phone:509-533-6910
Practice Address - Fax:509-535-2863
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALING LODGE OF THE SEVEN NATIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-07
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARTF-1023324500000X
3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA32150600OtherDSHA/DBHR