Provider Demographics
NPI:1508110370
Name:YAKAMA NATION CCAP
Entity Type:Organization
Organization Name:YAKAMA NATION CCAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-865-5121
Mailing Address - Street 1:P.O. BOX 151
Mailing Address - Street 2:20 GUNNYON ROAD
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948
Mailing Address - Country:US
Mailing Address - Phone:509-865-5121
Mailing Address - Fax:509-865-4333
Practice Address - Street 1:20 GUNNYON RD
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948
Practice Address - Country:US
Practice Address - Phone:509-865-5121
Practice Address - Fax:509-865-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 00001456261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP 00001456Medicaid