Provider Demographics
NPI:1407891088
Name:TRI-CITIES CHAPLAINCY
Entity Type:Organization
Organization Name:TRI-CITIES CHAPLAINCY
Other - Org Name:THE CHAPLAINCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING EXEC. DIR.
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA25IG00000X251G00000X
WA251G00000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3990124Medicaid
WA3990124Medicaid