Provider Demographics
NPI:1346432390
Name:WASHINGTON COMMUNITY
Entity Type:Organization
Organization Name:WASHINGTON COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE MANAGER FOR NUTRITION PROGRAM
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-653-5300
Mailing Address - Street 1:121 E MAIN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-2092
Mailing Address - Country:US
Mailing Address - Phone:319-653-5300
Mailing Address - Fax:319-653-2142
Practice Address - Street 1:121 E MAIN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-2092
Practice Address - Country:US
Practice Address - Phone:319-653-5300
Practice Address - Fax:319-653-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0177725Medicaid