Provider Demographics
NPI:1407979289
Name:LUMMI INDIAN BUSINESS COUNCIL
Entity Type:Organization
Organization Name:LUMMI INDIAN BUSINESS COUNCIL
Other - Org Name:LUMMI OTP, LUMMI CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING & REIMBURSEMENT SUPERV.
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOLSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-312-2489
Mailing Address - Street 1:2592 KWINA RD.
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-312-2285
Mailing Address - Fax:360-384-2336
Practice Address - Street 1:2616 KWINA RD.
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226
Practice Address - Country:US
Practice Address - Phone:360-312-2420
Practice Address - Fax:360-384-2349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUMMI INDIAN BUSINESS COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1991447Medicaid
WA1044098Medicaid