Provider Demographics
NPI:1437555471
Name:YAKIMA VALLEY COUNCIL ON ALCOHOLISM
Entity Type:Organization
Organization Name:YAKIMA VALLEY COUNCIL ON ALCOHOLISM
Other - Org Name:TRIUMPH TREATMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-853-4121
Mailing Address - Street 1:102 S NACHES AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2947
Mailing Address - Country:US
Mailing Address - Phone:509-248-1800
Mailing Address - Fax:
Practice Address - Street 1:3300 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6344
Practice Address - Country:US
Practice Address - Phone:509-571-1455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARTF.FS.60503751324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA123456789OtherTEMP