Provider Demographics
NPI:1609072016
Name:COUNCIL ON AGING & HUMAN SERVICES
Entity Type:Organization
Organization Name:COUNCIL ON AGING & HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-397-4611
Mailing Address - Street 1:210 S MAIN ST
Mailing Address - Street 2:PO BOX 107
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-1820
Mailing Address - Country:US
Mailing Address - Phone:509-394-4611
Mailing Address - Fax:509-397-2917
Practice Address - Street 1:210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-1820
Practice Address - Country:US
Practice Address - Phone:509-394-4611
Practice Address - Fax:509-397-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA051992OtherSSPS - COPES
WA9030859Medicaid