Provider Demographics
NPI:1639129695
Name:DSHS/DDA/YAKIMA VALLEY SCHOOL
Entity Type:Organization
Organization Name:DSHS/DDA/YAKIMA VALLEY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WINEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADMINIS
Authorized Official - Phone:509-698-1255
Mailing Address - Street 1:609 SPEYERS ROAD
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1050
Mailing Address - Country:US
Mailing Address - Phone:509-698-1300
Mailing Address - Fax:509-697-2230
Practice Address - Street 1:609 SPEYERS ROAD
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1050
Practice Address - Country:US
Practice Address - Phone:509-698-1300
Practice Address - Fax:509-698-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
313M00000X
WA342007865314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility