Provider Demographics
NPI:1558364216
Name:TOUTLE RIVER RANCH, INC.
Entity Type:Organization
Organization Name:TOUTLE RIVER RANCH, INC.
Other - Org Name:YOUTH AND FAMILY LINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DATA COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MANSKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-423-6741
Mailing Address - Street 1:PO BOX 2052
Mailing Address - Street 2:907 DOUGLAS STREET
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8179
Mailing Address - Country:US
Mailing Address - Phone:360-423-6741
Mailing Address - Fax:360-501-6510
Practice Address - Street 1:907 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2155
Practice Address - Country:US
Practice Address - Phone:360-423-6741
Practice Address - Fax:360-501-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA222251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7119834Medicaid