Provider Demographics
NPI:1558689711
Name:OLYMPIC COMMUNITY ACTION PROGRAMS
Entity Type:Organization
Organization Name:OLYMPIC COMMUNITY ACTION PROGRAMS
Other - Org Name:OLYCAP ORAL HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OLYCAP MEDICAID BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-452-4726
Mailing Address - Street 1:228 W 1ST ST
Mailing Address - Street 2:STE J
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-2639
Mailing Address - Country:US
Mailing Address - Phone:360-452-4726
Mailing Address - Fax:360-457-4331
Practice Address - Street 1:228 W 1ST ST
Practice Address - Street 2:STE J
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2639
Practice Address - Country:US
Practice Address - Phone:360-452-4726
Practice Address - Fax:360-457-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
WA600-443-619251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1026255Medicaid
WA5900691Medicaid