Provider Demographics
NPI:1528555109
Name:VADIS
Entity Type:Organization
Organization Name:VADIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF DEVELOPMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-863-5173
Mailing Address - Street 1:1701 ELM ST E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-2112
Mailing Address - Country:US
Mailing Address - Phone:253-863-5173
Mailing Address - Fax:253-863-2040
Practice Address - Street 1:1701 ELM ST E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-2112
Practice Address - Country:US
Practice Address - Phone:253-863-5173
Practice Address - Fax:253-863-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management