Provider Demographics
NPI:1477665081
Name:QUILLAYUTE VALLEY SCHOOL
Entity Type:Organization
Organization Name:QUILLAYUTE VALLEY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATIVE ASSISITANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-374-6262
Mailing Address - Street 1:411 S SPARTAN AVE
Mailing Address - Street 2:
Mailing Address - City:FORKS
Mailing Address - State:WA
Mailing Address - Zip Code:98331-9028
Mailing Address - Country:US
Mailing Address - Phone:360-374-6262
Mailing Address - Fax:360-374-2364
Practice Address - Street 1:411 S SPARTAN AVE
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9028
Practice Address - Country:US
Practice Address - Phone:360-374-6262
Practice Address - Fax:360-374-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442072Medicaid