Provider Demographics
NPI:1508056847
Name:COUNTY OF WALLA WALLA
Entity Type:Organization
Organization Name:COUNTY OF WALLA WALLA
Other - Org Name:DEPARTMENT OF HUMAN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-524-2920
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0329
Mailing Address - Country:US
Mailing Address - Phone:509-524-2920
Mailing Address - Fax:509-524-2993
Practice Address - Street 1:1520 KELLY PL
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8654
Practice Address - Country:US
Practice Address - Phone:509-524-2920
Practice Address - Fax:509-524-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251S00000X
WA1995034324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA251B00000XMedicaid
WA251S00000XMedicaid
WA251B00000XMedicaid